Enhancing Advance Care Planning in a Geriatric Clinic
Journal Title: Palliative Medicine & Hospice Care – Open Journal - Year 2018, Vol 4, Issue 1
Abstract
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.
Authors and Affiliations
James S. Powers
Keywords
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- DOI 10.17140/PMHCOJ-4-126
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