WREN Participates in PCORI-Supported Advance Care Planning Study

The Wisconsin Research and Education Network (WREN), a statewide primary care practice-based research network (PBRN) housed at the University of Wisconsin Department of Family Medicine and Community Health (DFMCH), is participating in a large collaborative study to improve advance care planning in primary care.

The study, funded through Patient-Centered Outcomes Research Institute® (PCORI®) award PLC-1609-36277, and led by Annette Totten, PhD, an associate professor of medical informatics and clinical epidemiology at Oregon Health & Science University, is comparing the effectiveness of two models of the Serious Illness Care Program (SICP).

Created by palliative care experts at Ariadne Labs, the SICP aims to help patients with serious illness have more, better, and earlier conversations with their clinicians about their goals, values, and priorities that will inform their future care. Only about one-third of adult patients have completed an advance directive of any type (source).

In the clinician-focused SICP model, the patient’s primary-care clinician is responsible for initiating and continuing conversations with patients and families about serious illness care planning.

In the team-based SICP model, those tasks are shared by a care team, which may include a nurse, social worker or community health worker.

Research Designed for Collaboration, Sustainability

WREN is one of seven PBRNs in the U.S. and Canada that is part of Meta-LARC, a consortium of PBRNs comprising over 900 primary care practices in rural, urban, and underserved communities.

WREN has recruited six Wisconsin clinics to join the study:

• Divine Savior Portage Clinic (Portage)
• Ascension Columbia St. Mary’s Ozaukee at Germantown (Germantown)
• Plymouth Family Physicians (Plymouth)
• Richland Medical Center (Richland Center)
• Plattevile Clinic at Southwest Health (Platteville)
• Northlakes Clinic (Hayward)

Participating clinics must have an interest in advance care planning, but no current standard program.

Each clinic is randomly assigned to one of the two SICP models, and will recruit approximately 40 adult patients with a life-limiting condition. To be eligible, patients must live in the community, not in a nursing home or be enrolled in hospice. At the time of enrollment, and again at six months and one year later, patients will answer questions about whether the health care provided matches their values, the amount of time spent at home and other outcomes

Staff at each clinic have an active role in training, workflow creation, documentation and follow up. As part of the study, they are also interviewed at the project start and at one and two years after training.

“The study is designed to be sustainable for clinics,” notes WREN Director David Hahn, MD, MS. “And by being part of WREN, participating clinics have a way to share what they’ve learned.”

Dr. Hahn added that the overall study is collaborative by design. One of the WREN advance care planning research team members is a patient, which aligns well with PCORI’s goal to include patients and family advisors at all stages of research. Each of the seven participating PBRNs also had a role in developing the study design.

Practice-based research networks, or PBRNs, are groups of primary care clinicians and practices working together to answer community-based health care questions and translate research findings into practice.

WREN, which was founded in 1987 as a collaborative effort between the department and the Wisconsin Academy of Family Physicians (WAFP), is one of the oldest PBRNs in the nation.

To learn more about the study, contact Dr. Hahn at dlhahn@wisc.edu.

Published: April 2019