Enhancing Advance Care Planning in a Geriatric Clinic

Abstract

Context
Academic primary care geriatric clinic.
Objective
We sought to increase advance care planning 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 ACP 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.