Developing a PREPARE for Your Care delivery system to enhance adoption by healthcare organizations

PROJECT SUMMARY Background: The population is aging, chronic illness is increasing, and millions of older adults lack preparation for complex medical decision making, leading to uninformed decisions and care inconsistent with personal goals. The goal of advance care planning (ACP) is to ensure that patients receive medical care aligned with their goals and preferences. Our team has created the evidenced-based, interactive online PREPAREforYourCare.org (PREPARE) ACP program that helps English and Spanish-speaking individuals develop the skills to clarify their values, communicate their wishes, and make informed medical decisions. In trials, PREPARE helped 98% of English and Spanish-speaking older adults engage in ACP and increased documentation of ACP decisions in the medical record up to 43%. Since 2013, PREPARE has had over 350,000 unique users and the materials have been translated into multiple languages; yet reach and adoption by healthcare systems remains low due to burdensome licensing and purchasing complexity, packaging of PREPARE materials that may not meet organizations’ needs, and lack of guidance for how to integrate the materials into clinical workflows. The objective of this proposal is to develop, refine, and evaluate an adopter-focused PREPARE Delivery System (PDS) to ease the process of selecting, licensing, and implementing PREPARE within healthcare organizations. The goal is to improve adoption and profitability of PREPARE and to position the team to apply for Phase II SBIR funding to test adoption and implementation among varying types of healthcare and related organizations. Aim 1: We will determine what PREPARE assets (i.e., website, advance directives, pamphlets, videos), are wanted by healthcare organizations and how organizations want to access and license the assets. Aim 2: We will build a PDS prototype that includes the desired assets and addresses stakeholder barriers to licensing and implementation. Aim 3: We will determine the feasibility of the PDS by pilot testing among stakeholder potential adopters. Methods: We will conduct in-depth interviews with healthcare stakeholders from a wide range of potential adopting organzations including community-based hospitals, county hospitals, tertiary academic medical centers, and healthcare-based community organizations and analyze the data using qualitative content analysis (Aims 1 and 2). We will also assess feasibility and satisfaction with the PDS using validated surveys and in-depth interviews (Aim 3). We hypothesize that stakeholders will identify preferred PREPARE assets and barriers to adoption, continue to provide feedback on needed refinements of the PDS over the course of development, and report that the PDS is feasible and report high satisfaction with the deliveray system. Relevance to NIH and public health: Widespread adoption and implementation of the evidenced-based PREPARE program may reduce health disparities in ACP among culturally and linguistically diverse older adults. Expected Outcomes include a functional PDS prototype and preliminary data to apply for Phase II funding in which we will further develop and deploy the PDS and measure adoption and dissemination of the PREPARE program within healthcare systems.