Enhancing Advance Care Planning in Primary Care: A Three-Year Implementation Study in Nebraska.

Area of Science:

• Geriatric Medicine
• Healthcare Management
• Implementation Science

Background:

• Advance care planning (ACP) uptake remains low in the U.S. despite its benefits for patient-centered care decisions.
• Identifying and addressing barriers to ACP implementation is crucial for improving healthcare outcomes.
• This study focused on enhancing ACP in primary care settings for older adults.

Purpose of the Study:

• To identify barriers hindering the implementation of advance care planning (ACP).
• To implement and evaluate two novel strategies: an onsite ACP coordinator and Lightning Report facilitation.
• To track and analyze ACP outcomes, including reach, implementation, and effectiveness.

Main Methods:

• A mixed-methods study was conducted at two primary care sites from 2020-2023, guided by the PRISM model.
• Qualitative data from staff interviews and focus groups identified barriers and informed workflow development.
• Quantitative data from electronic medical records assessed ACP reach and effectiveness over time.

Main Results:

• Prior to interventions, ACP reach and effectiveness showed minimal change between 2019-2021.
• Following the implementation of an ACP coordinator and Lightning Report in 2022, significant improvements were observed.
• Clinic A showed a 10-percentage point increase in reach and a 2.5 increase in effectiveness; Clinic B saw a 25.3-percentage point increase in reach and a 16.5 increase in effectiveness.

Conclusions:

• An onsite ACP coordinator combined with the Lightning Report approach effectively enhanced ACP reach and effectiveness.
• These strategies facilitated the integration of ACP into standard primary care workflows.
• The findings suggest a promising model for improving ACP implementation in geriatric primary care.