Enhancing Advance Care Planning in a Geriatric Clinic

Original Research | Volume 4 | Number 1| 1 Copyright 2018 by Powers JS. This is an open-access article distributed under Creative Commons Attribution 4.0 International License (CC BY 4.0), which allows to copy, redistribute, remix, transform, and reproduce in any medium or format, even commercially, provided the original work is properly cited. cc Context Academic primary care geriatric clinic. Objective We sought to increase advance care planning (ACP) discussions at an academic primary care geriatric clinic utilizing the electronic medical record (EMR). The measure was the number of documented ACP discussions. Methods Two plan-do-study-act (PDSA) quality improvement cycles. Phase 1: engagement of physicians and development of a patient information sheet with advanced directive forms for inclusion in the patient take-home clinic summary. Phase 2: engagement of clinic staff to screen for patient readiness for ACP discussions and to remind physicians. Results At baseline, 47.7% of patients had advanced directive documents in their EMR, and there was an 11.1% advance directive document completion following ACP discussions. Over a 3 month intervention, the rate of alternative dispute resolution (ADR) discussions remain unchanged at 3.4% of patients during Phase 1 but increased to 7.63% (94.6% increase) during Phase 2. Conclusions A team-based approach targeting patients prepared for ACP discussions was able to double incident new ACP discussions. Physicians identified several barriers to ACP discussions including patient readiness, time constraints, EMR constraints, and regulatory factors.