Statewide Implementation in Hawai’i

Evidence » Statewide Implementation in Hawai’i

Excerpt from the Journal of General Internal Medicine (2016): Use of Video Decisions Aids to Promote Advance Care Planning Hilo, Hawai'i1

Hilo, Hawaii

43,000 People

Inpatient ACP Documentation

Before

3%

After

40%

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

Hilo, Hawaii

37%

Control Region

26%

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

Before

6%

After

14%

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%.

$3,458

Average per patient savings for the last month of life in Hilo, Hawaii

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