DescriptionPurpose of Project: As the life spans of Americans are increasing so is the number of people who are living longer with multiple chronic comorbid conditions. End of life care can be protracted and very expensive. However, end of life treatment goals, articulated in advance care planning (ACP), can address these concerns. ACP is defined as the voluntary process in which patients discuss and communicate their future treatment and end-of-life preferences with their provider in case they lose their capacity to make decisions or communicate their wishes and preferences in the future. Primary care settings are ideal for the integration of ACP as part of routine care and health maintenance. However, a review of literature has shown that primary care patients do not routinely engage in ACP with their providers. As such, this project aimed to increase the number of ACP conversations that occur in a single primary care office and attempted to reduce provider associated barriers to ACP in the primary care setting.
Methodology: A quality improvement project that measured the effectiveness of an ACP educational module presented to participants in a live setting. Pretest and posttest design was used to compare participant knowledge base and attitudes towards ACP before and after intervention. Data was analyzed using the McNemar test. Frequencies of the number of times the ACP billing code was used were compared in the 4-week period both before and after intervention.
Results: This study resulted in a positive change in provider knowledge base and attitude towards ACP. Providers reported decreased apprehension in beginning ACP conversations with their patients as a result of the intervention. Additionally, the number of times ACP was billed for in the setting went from 0 pre-intervention to 336 in the post-intervention period. Moreover, a permanent integration of an ACP policy at the primary care center was put into effect as a result of the intervention.
Implications for Practice: This study demonstrated the feasibility of integrating ACP in primary care, increasing revenue for primary care settings, improving patient autonomy in end of life healthcare decision-making, and increasing the overall quality of healthcare services rendered.