A Knowledge Translation Project on Benchmark End-of-life Care Practices for the Elderly in Primary Care
The project was done at primary care practice sites at Fraser Health and several divisions of Family Practice in BC. Primary care physicians were directly involved as they are well positioned to provide palliative and end-of-life (EOL) care to patients.
Research Results
Findings: This project demonstrated that it is difficult but possible to translate best practice knowledge in EOL care into electronic medical record (EMR) specific tools for community-based providers. The EMR-specific tools are now available for OSCAR, Med Access and Profile EMR users.
About the Project
This three year project will increase the uptake of benchmark EOL care for elderly patients with advanced illness. It involved the development of quality indicators associated with primary care best practices in EOL care and promoting their integration into the EMR of practicing primary care physicians in British Columbia.
It looked to translate best practice knowledge in EOL care into a set of tools in the EMR for use by care providers in the community setting. The tools contain EMR-specific data entry templates, query/reporting functions, and access to downloadable resources such as advance care plans. They are based on the EOL learning module from the BC General Practice Services Committee Practice Support Program to improve EOL care by primary care providers in the province.
Project Team
Principal Investigators:
Francis Lau, PhD, MBA, MSc — University of Victoria
Doris Barwich, MD — University of British Columbia
Co-Investigators:
Neil Hilliard, MD — Fraser Health Authority
Bruce Hobson, MD — Private Practice, Powell River
Morgan Price, MD, PhD, CCFP — University of British Columbia
Project Contact: Francis Lau — fylau@uvic.ca
CORE 2012-13
Key words: knowledge translation; end-of-life care; primary care; elderly patients; advanced illness; electronic medical record
Key Findings for Families
- Doctors want to improve end-of-life (EOL) care but have many demands on their time and attention
- Electronic Medical Records (EMRs) can be used as tools to improve EOL care
- Organizations that help organize the delivery of health care need to work with doctors to make changes to EMRs to make them more useful for improving care
The findings from this study could help doctors know what the best way to take care of people at the end of their life
- If doctors are more confident, and have the help and support they need to take care of people during the end of their life, the care these people receive could be better
- Improving EMRs for those at the EOL, could provide patients and their family/caregivers with another resource in communication with their doctors. The patients and their family/caregivers may request a copy of their information that is stored in the doctor’s EMR
Why This Matters
Doctors do not have tools available when they take care of people during the end of their life. Improving the care of people at the end of their life is important to providing high quality care during this important time. This study wanted to see if EMRs may improve the care people at the end of their life receive.
About This Study
- This study included primary care practices in British Columbia and four primary care research networks across Canada
- There were five stages: (1) assessed current EOL care practice and tools in British Columbia; (2) developed EMR tools to support EOL care in British Columbia; (3) disseminated EMR tools to British Columbia providers; (4) assessed uptake of the EMR tools; and (5) assessed current EOL care documentation in EMRs across Canada
- The outcomes examined were provider confidence, documentation and use of EMR tools in EOL care
Key Findings for Policy
- Primary care providers want to improve end-of-life (EOL) care but have competing priorities and demands
- Organizational engagement needs to occur for large-scale practice improvement initiatives to be successful
This study identified barriers to successfully implementing electronic medical record (EMR) tools in EOL care.
- While EMRs may present a means of improving the quality of care during EOL through implementation of best practices, substantial barriers to the implementation were identified
- Some of the main barriers include: competing interests and demands of physicians, inadequate structure of EMR platforms, inconsistent documentation fails to identify patients in the EOL and engagement of organizations providing care
Why This Matters
Primary care providers lack point-of-care tools in managing patients at the EOL care, which is compounded by poor documentation in EMRs. Improving EOL care is important to improving the quality of care of patients during this crucial time. This study aimed to determine if EMR tools available at the point-of-care were an effective means of supporting best practices in EOL care.
Study Summary
- Implementation study to examine EMR tools for EOL care
- Study sites were primary care practices in British Columbia and four primary care research networks across Canada
- There were five stages: (1) assessed current EOL care practice and tools in British Columbia; (2) developed EMR tools to support EOL care in British Columbia; (3) disseminated EMR tools to British Columbia providers; (4) assessed uptake of the EMR tools; and (5) assessed current EOL care documentation in EMRs across Canada
- The outcomes examined were provider confidence, documentation and use of EMR tools in EOL care
Key Findings for Researchers
- Primary care providers want to improve end-of-life (EOL) care but have competing priorities and demands
- There is a need to improve EOL care documentation so these patients can be identified and managed ina proactive manner
- There is a need to align with provider organizations responsible for large-scale practice improvement initiatives to adopt emergency medical record (EMR)-supported EOL care
This study identified barriers to successfully implementing EMR tools in EOL care.
- Primary care providers are more confident and proactive in EOL care
- Improved EOL care documentation that can be shared among providers
Why This Study was Needed
Primary care providers lack point-of-care tools in managing patients at the EOL care, which is compounded by poor documentation in EMRs. Improving EOL care is important to improving the quality of care of patients during this crucial time. This study aimed to determine if EMR tools available at the point-of-care were an effective means of supporting best practices in EOL care.
How This Study Addresses the Gap
- This was a 30-month knowledge translation project to implement EMR-supported EOL care. The question was whether the palliative approach can be integrated into primary care EMRs to enhanc EOL care
- The project had five stages: (1) assessed current EOL care practice and tools in British Columbia; (2) developed EMR tools to support EOL care in British Columbia; (3) disseminated EMR tools to British Columbia providers; (4) assessed uptake of the EMR tools; and (5) assessed current EOL care documentation in EMRs across Canada
- The outcomes examined were provider confidence, documentation and use of the EMR tools in EOL care. The key kindings were: (1) providers lack of confidence and tools in EOL care; (2) current EOL care documentation in EMR is inconsistent; (3) providers want EMR tools to improve EOL care but have competing priorities; and (4) the need to align with provider organizations responsible for large- scale practice improvement initiatives
Future Research
- Need to demonstrate EMR-supported EOL care tools can improve the quality of EOL care transitions for elderly patients and their families
- Need to find effective ways to measure, scale up and sustain evidence-based EMR-supported EOL care practice in primary care
Publications
Lau, F., Barwich, D., Hilliard, N., Partridge, C., Hobson, B., Price, M. (October 2015). A Knowledge Translation Project on Best Practices in End-of-life Care. Driving Quality in Informatics: Fulfilling the Promise. A Knowledge Translation Project on Best Practices in End-of-life Care. Driving Quality in Informatics: Fulfilling the Promise, 208, 237pp.
Pyke, J. (May 2015). Government Publication. Journal of Family Practice Oncology (Spring 2015).
Pyke, J. (May 2015). Magazine Entry. Division in the News.
Presentations
Pyke, J., Lau, F. (March 2015). A Knowledge Translation Project on Benchmark End-of-life Care Practices for the Elderly in Primary Care. Island Health Seed Grant Abstract.
Pyke, J. (February 2015). A Knowledge Translation Project on Benchmark End-of-life Care Practices for the Elderly in Primary Care. ITCH 2015.
CFN Webinar (April 6, 2016): Benchmarking EOL care practices for elderly in primary care