Using CAN Scores to Increase Goals of Care Conversations at a Midwest VA Primary Care Department: A Quality Improvement Project
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Authors
Prendergast, Lindsay
Issue Date
2021-12-17
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Manuscript
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Abstract
Goals of Care conversations are a conversation with patients about life sustaining treatment. They are utilized as the first step to determine patient values and desires for healthcare in a Midwest Veterans Affairs (VA) Primary Care setting. A Care Assessment Need (CAN) Score is a tool used by the VA to identify patients that are at an increased risk of hospitalization and mortality. The use of the CAN scores may also help to identify patients and increase the number of documented goals of care conversations in the primary care setting. This quality improvement projected included veterans with a scheduled primary care appointment in a Midwest VA clinic. Patients with a CAN score between 85-95 that did not already have a documented goals of care conversation or a previous palliative care consult were identified for the project. During implementation, nurses used a planning tool to identify appropriate participants. The selected patients were sent information and called prior to the scheduled appointment. During the two-month period prior to intervention, 48 Life-Sustaining Treatment notes were completed by seven providers, and the appropriate billing code was encountered 27 times. During the two-month period during intervention, 80 LST notes were completed by 13 providers and the appropriate billing code was encountered 23 times. These findings indicate that CAN scores are useful to identify patients appropriate for goals of care conversations and increase documentation of goals of care conversations in the primary care setting. This quality improvement study was a short timeframe, and the number of LST notes may increase as more staff become involved in the process. Additional research at different VA facilities would be helpful. It is hard to replicate outside of the VA system since CAN scores are not readily available. Additional research would be helpful to determine another validated tool that could be used.
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Creighton University
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Copyright is retained by the Author. A non-exclusive distribution right is granted to Creighton University