Primary Care Interventions to Increase Provider-Patient Advance Care Planning Discussions

Abstract

Purpose: This project aimed to increase advance care planning conversations, between patients and primary care providers, at the Benson Family Care Clinic, through educating staff and making changes to clinic processes. Background: When implemented, advance care planning can have far reaching effects, which benefit patients and families. Over the past few years, there has been a movement in health care to promote advance care planning in primary care. Unfortunately, only about 33% of Americans have advance directives. Further, research shows that health care providers may not be comfortable having advance care planning conversations. The literature indicates that endeavors aimed at increasing health care staff knowledge and comfort, in advance care planning discussions may benefit patient outcomes. Methods: Three plan-do-study-act cycles were completed, which included iterative tests of change. Methods involved educating clinic staff and administration, and implementing system change. Participants in this project were five clinic staff members to whom an educational workshop was presented. The workshop included role-play with a standardized patient. System changes included increasing patient visit time for Medicare Wellness Exams from 30 to 45 minutes, which gave providers time to engages in advance care planning discussions. Pretest and posttest surveys assessed changes to participant self-perception of advance care planning conversations. Reports of advance care planning billing codes were used as a surrogate measure of advance care planning activity. Results: Baseline advance care planning activity was zero before this project began. By project end, 54% of patients seen for Medicare ‘well visits’ received advance care planning services. Further, project participants had an aggregate increase of 77% in self-assessed perceptions of advance care planning conversations after the educational workshop. Conclusions: This project was highly successful. Project findings support the literature regarding education as an effective tool in advance care planning uptake. Goals for increasing advance care planning activity were exceeded. This project is different from most in that site administration was included in educational endeavors and were vital to effective process change. The objective measure used in this project was instrumental to demonstrating substantial improvement in advance care planning activity.