Educational Interventions to Improve Advance Care Planning Discussions, Documentation and Billing

Area of Science:

• Geriatric Medicine
• Healthcare Quality Improvement
• Health Services Research

Background:

• Advance care planning (ACP) is crucial for ensuring patient preferences guide medical decisions, especially for individuals over 65.
• Existing healthcare systems often present barriers to consistent and effective ACP implementation.
• Interprofessional team engagement and workflow optimization are key to improving healthcare processes.

Purpose of the Study:

• To evaluate the impact of educational interventions, clinic workflow redesign, and quality improvement coaching on ACP activities.
• To assess changes in the frequency of ACP discussions, documentation, and billing among primary care providers.
• To identify effective strategies for enhancing ACP engagement in ambulatory care settings.

Main Methods:

• A nonrandomized before-and-after study was conducted across 13 ambulatory care clinics.
• Interventions included interprofessional ACP training, workflow redesign, and quality improvement coaching.
• Data collected included ACP discussions, written ACP documents in the EMR, and billed ACP encounters.

Main Results:

• Healthcare providers were more than twice as likely to conduct ACP discussions post-intervention.
• The likelihood of patients having an ACP document in their EMR increased by 1.4 times.
• Significant improvements in ACP billing were observed in one clinic (p < 0.05).

Conclusions:

• Comprehensive ACP education, workflow planning, and quality improvement coaching significantly enhance ACP activities.
• These integrated strategies lead to measurable improvements in ACP discussions and documentation.
• The findings support the scalability of these interventions to improve ACP rates in primary care.