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The Genevive Family Conference

Supporting Patients with Serious Illnesses

Ruby SchoenThe family conference is an important part of Genevive’s philosophy, as our geriatric medical practice and care management organization provides comprehensive care for 5,500 older adults in Minnesota. Our expert, compassionate value-based primary care and care coordination have a proven track record of improving quality outcomes. .

Our family conference is a structured five-step process led by the physician and nurse practitioner team in conjunction with the patient and family. The discussion aims to identify patient-centered goals of care, negotiate reasonable acute care plans, and review the chronic care plan considering the identified goals.

A family conference is offered to all our long-term care and home-based patients. We provide care to a large population of people enrolled in publicly subsidized health care programs, many with a complex interplay of multiple co-morbidities. These conditions make treatment decisions difficult and create a fine balance of risk versus benefit in any chosen management plan.

Patient centered

During the conference, we talk through complex medical decisions in the context of the patient’s personal choices, reducing the need to make rushed, less-informed decisions during a crisis. We use coaching techniques, like asking “If you could go back in time to when your Mom was living independently 10 years ago and gave her a crystal ball, and she could see her current life, how would she want us to treat her?”

An advance care plan (ACP) is written to ensure patients receive care that reflects their values, goals, and preferences.

Improve health care and lower costs

Reducing hospital readmissions, improving quality of life in advance illness, and deprescribing are national priorities for payers, providers, and policy makers seeking to improve health care and lower costs. The family conference addresses all these concerns, while personalizing treatment decisions for each patient.

During a Genevive family conference, we elicit goals of care to improve end-of-life. We discuss with patients and families recommended tests and procedures, and discourage superfluous ones. This can reduce excessive or unwanted medical treatment, tests, and procedures, especially those that do not alter the outcome or improve quality of life.

Family Conference Five Steps

Together, Genevive clinicians, patients and family talk through these steps.

  1. Tell the Story: Ask the patient to share their journey from independence to dependence.
  2. Summarize: Reflect back the big picture of the patient’s story.
  3. Elicit Goals of Care: Confirm the patient’s current quality of life and prognosis, then elicit goals of care with simple hope statements and focusing on patient preferences.
  4. Write an Advance Care Plan: Write orders for an acute care plan on the POLST form.
  5. Review the Chronic Care Plan: Discuss the agreed-upon goals of care and the risk-benefit of all interventions. This includes reviewing labs and appropriate subspecialty interventions, and potentially deprescribing medications after assessing for indication, efficacy, safety, and cost.

We discuss the potential of reducing medications to focus only on those that meet patient goals and are of benefit considering the patient’s clinical profile and functional status. Polypharmacy is problematic in our older patient population, and decreasing their drug use has both medical and economic benefits.

Structured for patient-centered care

Genevive’s innovative clinical model incorporates clinician ACP education and allows time to facilitate family conferences. We are paid on how well our patients are managed, and patient volume is not the primary driver.

Our patient-centered family conference is key to establishing individualized care plans. This engagement has been shown to improve clinical outcomes and quality of life.

Genevive’s mission is to treat patients like they are our own loved ones. It’s rewarding to know we are following patient wishes and goals of care that are consistent with their beliefs. The goal is not to cure, but to provide comfort and maintain the highest possible quality of life through the end.

Ruby Schoen, APRN, CNP, is a member of the Stratis Health Board of Directors. She is medical director and geriatric long-term care nurse practitioner at Genevive. Genevive is a stand-alone organization co-owned by Allina Health and Presbyterian Homes & Services.