Vanderbilt Geriatric Clinic Medical-Legal Partnership

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The Vanderbilt Geriatric Clinic is the geriatric faculty practice of Vanderbilt Internal Medicine, comprising a population of 2500 patients over the age of 65. Located on the Vanderbilt campus, it serves as the site for primary care and geriatrics exposure for Vanderbilt medical students and residents. Approximately 15% of the practice is hospitalized yearly, with a 5% yearly mortality rate.

This project seeks to build on an existing Medical-Legal Partnership (MLP) piloted by the Vanderbilt School of Nursing (VUSN) and Belmont College of Law

Increasing the prevalence of advance care planning discussions enhances quality of care and promotes patient self-determination. Patients expect providers to initiate advance directive conversations although there is no standard way to increase advance directive completion rates. A targeted discussion of advance care planning at the point of care may be an effective strategy.

An interdisciplinary team consisting of a graduate nurse and second year law student will counsel patients over the age of 65 immediately following their visit at the Vanderbilt Geriatric Clinic utilizing materials based on the PREPARE checklist. Patients are given the opportunity to complete advance directives at the point of care, or to keep the materials for further discussions with family members. Completed advance directives are scanned into the EMR. Trainees are under the direct supervision of faculty from the School of Nursing and the College of Law at Belmont University (School of Nursing consultants). Data collection of outcome measures will include the number of patients over age 65 with completed advance directives and the number of patients over age 65 with documentation that an advance directive care plan was discussed but that the patient did not wish to provide advance care planning documents.  Training feedback to faculty (workflow, communications styles, patient reaction to advance directive discussions) will inform implementation strategies to reach patients and providers in additional clinical settings.