Increasing Advance Care Planning Completion at an Academic Internal Medicine Outpatient Clinic

Ngoc-Phuong Luu; Candace Nigrin; Kimberly Peairs; Sydney M Dy; Melinda Sawyer; Samantha Pitts; Brent Petty

doi:10.1016/j.jpainsymman.2017.05.006

Increasing Advance Care Planning Completion at an Academic Internal Medicine Outpatient Clinic

J Pain Symptom Manage. 2017 Sep;54(3):383-386. doi: 10.1016/j.jpainsymman.2017.05.006. Epub 2017 Aug 8.

Authors

Ngoc-Phuong Luu¹, Candace Nigrin², Kimberly Peairs³, Sydney M Dy⁴, Melinda Sawyer⁵, Samantha Pitts⁶, Brent Petty⁷

Affiliations

¹ Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. Electronic address: Nluu3@jhmi.edu.
² Green Spring Station Internal Medicine Clinic, Lutherville, Maryland, USA.
³ Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Green Spring Station Internal Medicine Clinic, Lutherville, Maryland, USA.
⁴ Green Spring Station Internal Medicine Clinic, Lutherville, Maryland, USA; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA; Johns Hopkins Armstrong Institute of Patient Safety and Quality, Baltimore, Maryland, USA.
⁵ Johns Hopkins Armstrong Institute of Patient Safety and Quality, Baltimore, Maryland, USA.
⁶ Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Johns Hopkins Armstrong Institute of Patient Safety and Quality, Baltimore, Maryland, USA.
⁷ Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

PMID: 28797865
DOI: 10.1016/j.jpainsymman.2017.05.006

Abstract

Background: We sought to increase advance care planning (ACP) completion at an academic internal medicine clinic through an electronic health record.

Measures: Number of eligible patients who completed a form of ACP.

Intervention: Multidisciplinary team approach with engagement from providers and clinic staff; implemented informational letter and appropriate forms to eligible patients before appointment; informational video and provider reminders at time of appointment.

Outcomes: Of 480 eligible patients, 327 (68%) completed one or more forms of ACP or had a discussion with their provider. Discussed but not completed was highest (53%). The three types of ACP completed were 1) a state-formatted advance directive form (47%), 2) Medical Orders for Life-Sustaining Treatment (45%), and 3) power of attorney designation (8%).

Conclusions: Implementation of a multi-disciplinary approach can facilitate ACP. However, challenges still arise because in more than half of the cases, advance care efforts led only to a discussion.

Keywords: Advance care planning; MOLST; advance directive; power of attorney.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Academic Medical Centers* / methods
Advance Care Planning*
Aged
Ambulatory Care Facilities*
Electronic Health Records*
Health Communication
Health Personnel
Humans
Internal Medicine* / methods
Quality Improvement