Increasing Access to Advanced Care Planning Documentation

The purpose of this project was to determine the percent of the adult patient population at one family practice in Vermont with completed advanced care planning documentation available to health care providers and work to increase that percentage. The majority of this project was spent completing a chart review to find the advanced care planning documentation present in the current electronic health record, Epic, the previous electronic health record, ECW, or registered with the Vermont Advance Directive Registry. Efforts were also made to increase the percent of adult patients with advanced care planning documentation through conversations with patients during wellness and chronic care visits. Overall, in this practice approximately 14% of adult patients were found to have completed advanced care planning documentation which is less than the national average of approximately 33% of all adults. Discussion of further research on how to increase this percentage is ongoing.https://scholarworks.uvm.edu/fmclerk/1876/thumbnail.jp

University of Vermont Medical Center Critical Care Transport Community Paramedicine Pilot Inclusion/Exclusion Criteria and Supplemental Materials

The University of Vermont Medical Center (UVMMC) Critical Care Transport (CCT) team received a grant in 2020 to trial one Community Paramedic to reduce high volume utilizers of UVMMC’s ED enrolled in Vermont’s accountable care organization (ACO), OneCareVT. That summer, this team helped develop and analyze the implications of that program. The current literature surrounding Community Paramedicine was explored, focusing particularly on studies that analyzed costs savings of these programs, rural areas with similar populations as Vermont, and the average cost of an ED visit. The reviewed literature and annotations are included in this work. Initially, our plan was to analyze data obtained from the Critical Care Transport team’s pilot program. However, the program was slated to begin at the beginning of April 2020 and was postponed in the wake of the COVID-19 pandemic. The department’s Community Paramedic was instead reallocated to set up the drive-through COVID-19 testing site for Chittenden County. The reallocation of resources from UVMMC’s CCT team prompted this team’ to pivot efforts toward the fundamental establishment of the program – particularly patient selection. 78 high utilizers of UVMMC’s ED for six months in 2020 were reviewed. Following the chart review trends in chronic underlying conditions and chief complaints were established within this cohort. With these data, inclusion criteria and exclusion criteria for a community paramedic pilot program were generated further taking into the considerations the abilities and limitations of community paramedics, safety, and other community resources available for this patient population. These criteria are included within this work. With the pivot from data collection to assisting with program set up, a mail-out letter to send to potential patients who might benefit from the program was written. Additionally, a script for contacting these patients via telephone to enroll them in the program was also written. These resources are also included within this work