SHM Converge Scientific Abstract ePoster Gallery-Hospitalist Serious Illness Conversation Implementation to Facilitate Improved Healthsytem Outcomes

Pdf Summary

Essentia Health identified poor hospice utilization, limited advance care planning, and suboptimal readmission and mortality metrics among Medicare Shared Savings Program patients, especially in a rural referral population. To address this, the health system launched a rapid implementation of the Serious Illness Conversation Guide (SICG), beginning with hospitalists, who were seen as the best group to drive change.<br /><br />In 2023, 80 clinicians were trained over four months, with hospitalist participation tied to a group quality measure and supported by EMR documentation and billing education. During the implementation period, 357 serious illness conversations were documented, with 60% of trained clinicians participating and the entire hospitalist group using the tool. Most documented conversations came from non-palliative care clinicians.<br /><br />The intervention was associated with several early improvements: hospice referrals doubled from 18 to 37 per month, outpatient hospice daily census increased by 9.8%, inpatient mortality ratio declined from 1.01 to 0.9, and palliative care consults temporarily decreased before returning to baseline. Survey results were positive: 78% of responding hospitalists reported using SICG, 95% felt supported in having these conversations, 67% felt more satisfied in their role, and 84% felt confident billing for the service.<br /><br />The project concluded that hospitalist-led SICG implementation can improve value-based outcomes, increase clinician comfort and satisfaction, and serve as a model for broader system-wide adoption. The presentation emphasized that serious illness conversations should be started early rather than delayed.

Asset Subtitle

John J. Degelau

Meta Tag

Author List John J. Degelau, Karyn Baum, Melissa Simonson, Nathan Palmolea, Wanda Paulsen

Category Innovations

Concept Serious Illness Discussion

Concept Hospitalist Group

Concept Goals of Care Discussion

Concept Serious Illness Conversation

Concept End-of-Life Healthcare Utilization

Distinguished Non-Finalist

Presenter Organization Essentia Health

Presenting Author John J. Degelau

Track Value in Hospital Medicine

Keywords

hospice utilization

advance care planning

serious illness conversation guide

hospitalist-led implementation

Medicare Shared Savings Program

palliative care

readmission metrics

mortality outcomes

rural referral population

value-based care

Serious Illness Discussion

Hospitalist Group

Goals of Care Discussion

Serious Illness Conversation

End-of-Life Healthcare Utilization