50% Clinic or Home
Verbal description of Goals of Care
Video description of Goals of Care
> 64 Years of Age
Advanced HF Diagnosis
Goals of Care
Life Prolonging Care Limited Medical Care Comfort Care Unsure
The Patient Experience
of patients would recommend the video to others.
of patients comfortable watching the video.
Did the patient have a
Goals of Care conversation?
After 1 Month
After 3 Months
Inpatient ACP Documentation
Prior to implementation of the videos, the rate of ACP completion for patients with late-stage disease was 3.2%. In the 21 months after the intervention, there was an increase in ACP documentation to 39.9%.
ACP documentation included completion of an advance directive, designating a durable power of attorney, a Physician Orders for Life-Sustaining Treatment (POLST) form, or any documentation of the patient’s ACP preferences in the medical record. The primary document completed was a POLST form.
Ambulatory ACP Documentation
Primary care providers in Hilo had an ACP completion rate for this cohort of 37% compared to all other providers in the state, who had an average of 25.6%. (P < 0.001).
Hospital Referrals to Hospice
Prior to implementation of the videos, the rate of discharge to hospice for hospitalized patients with late-stage disease was 5.7%. After the intervention, there was an increase of late-stage patients discharged to hospice to 13.8%.
Average per patient savings for the last month of life in Hilo, Hawaii