Increasing Documentation of Advanced Care Planning in Primary Care by an Interprofessional Student Team
Interprofessional Student Poster Description:
We are an interprofessional team including a pharmacy, nursing, and medical student as part of the Vanderbilt Program of Interprofessional Learning, a 2-year longitudinal and clinically-based interprofessional program. As part of the program, students are asked to design and implement an improvement project. Our team wanted to improve advanced care planning (ACP), as two-thirds of US adults have no ACP for end-of-life care1. This document allows patients to make their own medical decisions while they can employ their autonomous voice and it alleviates stress on loved ones. With ACP in the electronic health record (EHR), providers can easily access patient wishes. At the end of 2022, our preceptor had ACP documentation for 43% of her Medicare patients. Our aim was to increase documentation of ACP in the EHR for Medicare patients by 5% over a three-month period.
We measured the percentage of patients with ACP before and after the creation and distribution to all Medicare patients of a 1-page handout explaining ACP and its treatment options. The team answered any questions regarding ACP and the treatment options. We asked patients explicitly whether they have ACP. If yes, we ensured it is in the chart or we asked the patient to provide a copy for the chart. If not, we asked if they want to complete ACP and helped them complete the form during the appointment or let them take the form home to be returned.
Of a panel of 390 Medicare patients, between January 1 and April 3, 2023, ACP documentation increased by 6.5%. Of the 58 patients with appointments in the project timeframe, 20 already had ACP, 22 completed ACP during their appointment, 16 planned to complete ACP at home, and 0 denied ACP completely. Before the intervention, 35% of the 58 patients had ACP; afterward, the percentage doubled to 72%.
Our interprofessional student team successfully addressed a need in our primary care clinic, surpassing our goal for ACP documentation. We learned that ACP documents are confusing to patients and providers alike. Many patients want ACP but do not know how to access it. Providers often skip asking about ACP. Finally, ACP forms do not require notarization; they are valid if witnessed by two non-agents. In the future, all patients, regardless of age or insurance, should be given this ACP educational handout to increase ACP education and access.