Programs and Communities
The collection collates collections by schools, centers, programs, and research groups.
Filtering by
- All Subjects: Advance Care Planning
- All Subjects: Equity
Disease burden is higher in the United States than in comparable countries. The Patient Self Determination Act of 1990 requires healthcare facilities to provide Advance Care Planning (ACP) information to all Medicare patients. The healthcare staffs’ (n=7) commitment to 3-days of ACP training increase ACP rates in the primary care setting. The Medicare Incentive Program is the platform for this initiative. This quantitative project used a valid and reliable pre and posttest design that consisted of 27 items on a Likert-scale. A 3.5-month chart audit (n=91) was conducted to assess the completion rate. Descriptive statistics was used to describe the demographic data.
The results of the two-tailed Wilcoxon signed rank test were significant based on an alpha value of 0.05, V = 0.00, z = -2.37, p = .018. There was a significant increase in the post-readiness to change average scores. A Mann Whitney test was used to analyze the statistically significant difference between the averages in two ACP types and electronic health record documentation (EHR). Staff did not always code (Mdn = 0.00) but they documented in the EHR (Mdn =1.00; 512.00, p = 0.003). ACP discussion was performed 63% of the time during Annual Wellness Visits (AWV), and there was a 49% increase in the EHR documentation. Trained staff are key stakeholders in guiding ACP conversations. They understand the barriers, impact, and consequences related to the lack of advance directives.
Background and Significance: National regulations mandate that patients are provided information about advance directives in the healthcare setting, but completion rates are not monitored and continue to be low. ACP is now a billable service for healthcare providers, but it has not provided enough incentive to increase completion rates. Barriers for healthcare providers in the outpatient setting include lack of time, protocols, and lack of education on how to initiate and foster advance care planning discussions.
Methods: Healthcare providers in a primary care office attended a 15-minute structured educational session with and a toolkit was provided on the importance of ACP, how to initiate conversations with patients, and bill for the service. Participants completed a portion of the Knowledge, Attitudinal, and Experiential Survey on Advance Directives (KAESAD) survey assessing their confidence in ACP before and three months post intervention. Participant confidence (N = 6) in ACP was analyzed using the Wilcoxin test and descriptive statistics. The number of billed ACP services for the office was collected for four months post intervention and compared to the previous four months. Outcomes: A significant increase in provider confidence after participating in a multimodality education program was found in the results (Z = -2.21, p = .03). There was a 42.1% increase in the number of billed ACP discussions for the office in the four months post intervention.
Conclusion: The future desired state is that ACP discussions become standard practice in primary care leading to the completion of advance directives. This can be accomplished through formalized education sessions and resources for providers in order to increase their confidence in initiating ACP discussions with patients. The ultimate goal is to decrease unnecessary spending at end-of-life while improving patient and family satisfaction with the quality of care received at end-of-life.
The project used a mixed method design. Participants were recruited from a primary care practice. Descriptive statistics described the sample and outcome variable. An independent t- test measured if there were significant changes in the participant responses for the ACP survey.
The average age (standard deviation) of the chart review sample was 72.22 (SD=9.47). The ages ranged from 60 to 100 years of age. Most of the sample in the chart audit were female with 105 (53%) participants and 95 (48%) were male. Most of the sample, 183 (92.5%) reported having a chronic health condition and 17 (7.5%) of the sample reported having no chronic condition. Overall, the results were inclined towards a significant difference in participants who did the ACP discussions and those who did not when comparing completed AD forms.
As Baby Boomers age, the number of older homeless patients facing end of life is increasing. Homeless individuals die of the same diseases as their domiciled counterparts, but they have distinct barriers to equitable end-of-life care, such as lack of regular medical care, a higher likelihood of comorbid serious mental illness and substance abuse, alienation from potential healthcare proxies, and specific fears related to dying. Completion of an advance directive (AD) would address many of these barriers, as well as national goals of reducing medical costs associated with end of life care. A review of the literature indicates that homeless individuals, once educated on the purpose and significance of ADs, complete them at a higher rate than non-homeless people. Further, racial and ethnic disparities in document completion are minimized with educational interventions about an AD’s purpose.
King’s Theory of Goal Attainment provides the theoretical basis for the application of such an intervention in the setting of a medical respite center and a day resource center that both serve the homeless. Thirty-seven clients of the two sites and 14 staff members were administered a pre-and post-test measuring attitudes and knowledge relating to ADs on a Likert scale, resulting in an increase in knowledge about one of the two documents that traditionally comprise an AD, while not significantly affecting attitudes. Implications for practice include an inexpensive intervention that does not require a medically trained individual to deliver, enabling a broad application to a variety of settings with the goal of empowering a traditionally disenfranchised population to make health decisions related to the most vulnerable of life passages.
The electric transportation (ET) and electric vehicle (EV) landscape is currently inequitable and inaccessible for many living in the Phoenix area. This is especially true for people without single-occupancy vehicles (SOVs), who are reliant on public transit, or do not live in the Metropolitan center. Transit is intricately related to the environment and, due to societal and political structures, most of these environmental injustices are concentrated in low-income and minority communities. The lack of political representation within these communities has led to increased exposure to a variety of issues. Equitable transportation has also suffered due to a significant gap in addressing the needs of these underserved communities (Bolin, et al., 2005). The concentration of inequities and environmental injustices is a direct result of the lack of representation. Therefore, equitable and inclusive collaboration on solutions is required in order to maintain fairness and access, (Clement, 2020) considering the legacy of institutional harm within historically marginalized communities. The TE Activator was created by Salt River Project (SRP) and Anthesis Group, a sustainability consulting agency. The Activator is a group of Phoenix-area organizations interested in shaping the ET landscape to positively influence the well-being of Arizonans. With this in mind, they have asked our team to focus on making the transition to electric transportation equitable and inclusive. Our report details the current state of electric transportation nationally and locally, analyzes equitable EV/ET programs and utility plans across the country, and reviews the City of Tempe’s electric transportation related efforts. For this, we conducted listening sessions with a national expert, the City of Tempe, Tempe Community Action Agency, and CHISPA, creating a Community Listening Pilot Project based on the preliminary listening sessions. Through our research, listening, and discussions we compiled tiered recommendations for the TE Activator that suggest systemic policy changes based on community priorities. Accompanying the report is an Equity Roadmap, Community Listening Script, and one-page Debrief.
The electric transportation (ET) and electric vehicle (EV) landscape is currently inequitable and inaccessible for many living in the Phoenix area. This is especially true for people without single-occupancy vehicles (SOVs), who are reliant on public transit, or do not live in the Metropolitan center. Transit is intricately related to the environment and, due to societal and political structures, most of these environmental injustices are concentrated in low-income and minority communities. The lack of political representation within these communities has led to increased exposure to a variety of issues. Equitable transportation has also suffered due to a significant gap in addressing the needs of these underserved communities (Bolin, et al., 2005). The concentration of inequities and environmental injustices is a direct result of the lack of representation. Therefore, equitable and inclusive collaboration on solutions is required in order to maintain fairness and access, (Clement, 2020) considering the legacy of institutional harm within historically marginalized communities. The TE Activator was created by Salt River Project (SRP) and Anthesis Group, a sustainability consulting agency. The Activator is a group of Phoenix-area organizations interested in shaping the ET landscape to positively influence the well-being of Arizonans. With this in mind, they have asked our team to focus on making the transition to electric transportation equitable and inclusive. Our report details the current state of electric transportation nationally and locally, analyzes equitable EV/ET programs and utility plans across the country, and reviews the City of Tempe’s electric transportation related efforts. For this, we conducted listening sessions with a national expert, the City of Tempe, Tempe Community Action Agency, and CHISPA, creating a Community Listening Pilot Project based on the preliminary listening sessions. Through our research, listening, and discussions we compiled tiered recommendations for the TE Activator that suggest systemic policy changes based on community priorities. Accompanying the report is an Equity Roadmap, Community Listening Script, and one-page Debrief.