Earlier identification of seriously ill patients: an implementation case series.

Objective: To describe the strategies used by a collection of healthcare systems to apply different methods of identifying seriously ill patients for a targeted palliative care intervention to improve communication around goals and values.
Methods: We present an implementation case series describing the experiences, challenges and best practices in applying patient selection strategies across multiple healthcare systems implementing the Serious Illness Care Program (SICP).
Results: Five sites across the USA and England described their individual experiences implementing patient selection as part of the SICP. They employed a combination of clinician screens (such as the 'Surprise Question'), disease-specific criteria, existing registries or algorithms as a starting point. Notably, each describes adaptation and evolution of their patient selection methodology over time, with several sites moving towards using more advanced machine learning-based analytical approaches.
Conclusions: Involving clinical and programme staff to choose a simple initial method for patient identification is the ideal starting place for selecting patients for palliative care interventions. However, improving and refining methods over time is important and we need ongoing research into better patient selection methodologies that move beyond mortality prediction and instead focus on identifying seriously ill patients-those with poor quality of life, worsening functional status and medical care that is negatively impacting their families.
Competing Interests: Competing interests: AG reports receiving royalties from publishers and media outlets worldwide for writing and other media on healthcare including the subject of serious illness care and checklists during the conduct of this study. AG is also employed as the CEO of the new non-profit-seeking healthcare venture parented by Amazon, Berkshire Hathaway and JP Morgan Chase. JRL reports grants from The Gordon and Betty Moore Foundation, during the conduct of the study; grants from Cambia Health Foundation, outside the submitted work; and JRL receives salary support funding for work related to the Serious Illness Care Program (studied in this manuscript) from his home institutions. Additionally, he receives teaching honoraria related to his academic work on the Program from government and academic entities. EKF reports grants and other from the Gordon and Betty Moore Foundation during the conduct of this study, and is the Director of the Serious Illness Care Program, the quality improvement program referenced in the paper.
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