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Copilots in Care - Planning Simplified

Integrating compassionate in-person support with technology to guide end-of-life conversations with patients, families, and doctors.

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Who is your idea designed for and how does it reimagine the end-of-life experience?

Our service empowers diverse patients and families to communicate what matters most with informed confidence.An empathetic social worker,or Copilot,aligned with cultural and conversational preferences,provides individualized support through guided reflection and education via digital platform.Through Copilot-facilitated in-person conversations between patients, families, and doctors to address points of miscommunication, complete ACP documents are shared and updated through consistent follow-up.

Today 70% of seniors want to pass away at home, but only 30% actually do. Why patients are not getting the care they want at the end of life comes from communication barriers between patients, their families, and their medical providers. Many of these barriers result from a general lack of understanding of available options, limited transparency or involvement with the care process, and discomfort from all parties about talking about death and dying. So is it that patients find it difficult to navigate the options they have, and do not feel comfortable enough or know how to ask their medical provider. Most medical providers, on the other hand, do not have the time or the confidence to initiate and sustain these conversations due to a lack of proper training and language, cultural, and religious barriers and disparities in health literacy that significantly impede efficient and effective conversation. Families are not often kept on the same page throughout the process, with personal biases that can lead to paternalistic decision-making that is not aligned with the patient’s goals. And even when these conversations do occur, they are often removed from the process of official documentation, creating further vulnerability to miscommunication during a time of crisis.

Addressing these barriers requires not only redesigning how advance care planning should be approached, but also consideration of who should be initiating these conversations. Copilots In Care addresses this communication inefficiency by removing the activation barrier to starting advance care planning conversations off both medical providers and patients. We enable sustained and receptive communication by combining an accessible digital platform with an empathetic social worker (or Copilot) matched with the patient through a predictive algorithm. Copilots guide patients and their families through a set of reflection questions and educational materials designed to help them determine how they can achieve what matters most to them. After completion of this reflection and education process, Copilots meet with patients and their family in-person to facilitate discussion about their responses and complete proper documentation (i.e., the POLST and advance directive) that is sent to the medical provider. Finally, prepared and informed patients and their family then meet with their medical provider for an efficient conversation guided by a checklist of discussion points. With continuous follow-up to ensure that documentation is kept up-to-date and aligned with the patient’s wishes as their condition changes, the result is a patient with more confidence, a family with less stress, a provider with fewer burdensome conversations, and an insurer with less unwanted interventions.

For more information, please visit our website at http://www.copilotsincare.com/.

What early, lightweight experiment might you try out in your own community to find out if the idea will meet your expectations?

We completed a pilot study with 55 terminal patients in the Bay Area.Our approach created high engagement (51% completed an ACP) and satisfaction (NPS of 81) for patients, families, and doctors. Selling these results to Medicare Advantage Plans, reaction was more enthusiastic than we imagined;we have two contracts 95% through negotiation and a third a month behind. Next steps:implement these contracts and run small experiments to further improve engagement and satisfaction.It’s an exciting time!

What skills, input or guidance from the OpenIDEO community would be most helpful in building out or refining your idea?

We could use the OpenIDEO community’s help with design and branding to build trust with our clients as we seek to improve our engagement rate and satisfaction score.

Tell us about your work experience:

Colin, David, and Eric founded Copilots In Care in June 2015. As graduates from Stanford and MIT, with extensive experience in product design, entrepreneurship, data science, medicine, healthcare, and business, they are passionate about their mission to help patients get the care they want.

This idea emerged from

  • A group brainstorm

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Team

WOW! Chandra, it's been 3 years since I presented this idea! Good things come to those who wait??
My professional dream has been to bring the Integrative Healing Arts to the bedside, especially at the End of Life. I have been practicing the Healing Arts since becoming an RN almost 40 years ago!
I am a Care Coordination RN with Sutter, part time.
I have held a national Board Certification in Holistic Nursing since 1999.
Hospice and Palliative care are my specialties, and once a Hospice Nurse, always a Hospice Nurse. I have been teaching the Integrative Healing Arts program to nurses at Sutter Health for many years, and we have adopted policies, procedures and protocols for this program.
This program has shown that not only is this great for the patients, but staff benefit, which is the way healing works when environments of healing are created. Surveys show this program enhances care and the quality of the caring.
I have also been in touch with Shoshanna Ungerleider over the years and she has shown an interest in possibly using this program to teach her Palliative Care Resident MDs.
I have been approached by a Nurse Executive with Vitas Home Hospice in the SF East Bay, the largest organization in the region. She has asked to bring this to her volunteers.
I am ready and waiting for an opportunity to share this, and to be a CoPilot with you.
Please feel free to contact me, 415 847 6565
Peraa@gmail.com
Peraa@sutterhealth.org.
Let's see what we can do!




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