Improving Ambulatory Health Care Proxy Completion Rates: Implementing an Interdisciplinary Clinic-Based Process.

Area of Science:

• Primary Care Medicine
• Health Services Research
• Public Health

Background:

• Health care proxies (HCPs) are vital for ensuring patient autonomy, particularly for those with serious illnesses or at risk of losing capacity.
• Implementing effective strategies to increase HCP completion rates in primary care settings remains a challenge.

Purpose of the Study:

• To describe the implementation of an interdisciplinary process for assisting patients in completing health care proxies during routine primary care visits.
• To evaluate the impact of this process on HCP completion rates within an urban academic primary care practice.

Main Methods:

• The study employed direct observations to map the interdisciplinary process for HCP completion.
• Pre- and post-implementation data were collected to measure changes in HCP completion percentages.
• Physician leaders identified key facilitators and barriers to the implementation process.

Main Results:

• A significant improvement in HCP completion rates was observed post-implementation (1.4% vs 26.1% in the North Suite).
• The overall percentage of patients with HCP information in the clinic rose substantially (e.g., 37% to 80% in the North Suite).
• Statistical analysis confirmed the significance of these improvements (Fisher exact test P < .0001).

Conclusions:

• An interdisciplinary approach integrated into primary care can sustainably increase the percentage of patients with completed health care proxies.
• This process facilitates advance care planning and ensures better alignment with patient preferences.
• The findings support the scalability of such interventions in diverse primary care settings.