End of Life
PSP Module
End of LifePSP Improvement Charter
What are we trying to accomplish?
We aim to improve “end of life” care for patients and familiesby;
improving the identification process, end of life assessment, discussions r/t end of life, completed advanced directives, collaborative care planning, better coordination, and communication with patients, families, caregivers, healthcare providers and other health related affiliates within communities.Byworking on this process now we expect to improve the care of patients and families living with and dying from life limiting and chronic illnesses, while improving the patient/family and provider experience. It is important to do this work now because there are GPSC incentives and new guidelines to support GPs to provide collaborative care to patients and their families at and end of life.
How will we know that a change is an improvement? Our measures are:
Measure / Type of measure / Description of Measure / Goal
“end of life” registry / Process / # of pts identified and placed on a registry / Practice specific
Collaborative care plan / Process / % of patients on a registry with a collaborative proactive care plan in place / 90%
My Voice / Process / % patient on registry who have been given My Voice (or other) and had an ACP conversation / 90%
ESS and/or PPS / Process / % of pts on the registry that had an ESAS and or PPS (as appropriate) / 90%
Practitioner confidence level / Outcome / % of practitioners that are confident when engaging patients and their family in conversations about end of life (1-10 confidence scale) / 90%
Patient comfort level / Outcome / % of patients/caregivers who feel comfortable with the end of life care plan / 80%
Caregiver support / Outcome / % of caregivers who feel supported when caring for patients at end of life / 95%
Provider experience / Outcome / % of GPs and healthcare providers that have an improved experience in caring for patients at end of life / 90%
End of Life PSP charter Mar 171 of 2
End of Life
PSP Module
Team Members:
Dr. Cathy Clelland – Chair
Sheila Balson, Interior Health Authority
Andy Basi, PSP Central
Sherry Barr, Ministry of Health
Dr. Doris Barwich, Fraser Health Authority
Isaac Buwembo, ImpactBC
Dr. Clifford Chan-Yan
Dr. Ian Courtice, BCMA
Louise Donald, Vancouver Coastal Health Authority
Dr. Neil Hilliard, Fraser Health Authority
Pamela Hinada, PSP Central
Dr. Bruce Hobson, BCMA
Dr. Marcus Hollander, Hollander Analytical Services
Dr. Marnie Jacobsen, BCMA
Pauline James, Ministry of Health
Judy Huska, ImpactBC
Liza Kallstrom, PSP Central
Dr. Douglas McGregor, Vancouver Coastal Health Authority
Pat Porterfield, Vancouver Coastal Health Authority
Dr. Chris Raucher, Fraser Health Authority
Della Roberts, Fraser Health Authority
Christina Southey, ImpactBC
Dr. Romayne Gallagher, Providence Health Care
End of Life PSP charter Mar 171 of 2