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Increasing Health Care Agent Documentation in a Residency Clinic.

Mariah Eggebraaten1, Janisha Manhas2, Zach Merten1

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Summary

Implementing a simple intervention increased health care agent (HCA) documentation for advance care planning (ACP). This initiative also revealed a significant need to update existing ACP documents for better patient care wishes communication.

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Area of Science:

  • Healthcare Management
  • Patient Advocacy
  • Medical Documentation

Background:

  • Advance care planning (ACP) involves documenting patient wishes through health care agent (HCA) forms.
  • Effective HCA documentation is crucial for clinicians to understand and respect patient care preferences.
  • This study addresses the need to improve the habituation of ACP conversations and increase documentation rates.

Purpose of the Study:

  • To implement and evaluate a workflow redesign and educational intervention aimed at increasing health care agent (HCA) documentation rates.
  • To assess the impact of a patient-facing educational tool on initiating advance care planning (ACP) discussions.
  • To identify the prevalence of outdated ACP/HCA documentation within the patient population.

Main Methods:

  • A workflow redesign and novel educational interventions were implemented.
  • Patients aged 50 and older were provided with an HCA education "blue sheet" at check-in to prompt discussions.
  • Chart audits were conducted to assess documentation status and identify outdated records.

Main Results:

  • The intervention was delivered to 44% of 968 patient visits, resulting in a 4% increase in HCA documentation.
  • Chart audits revealed that 69% of patients had ACP/HCA documentation older than five years.
  • Clinicians and staff reported the process as helpful, important to patients, and sustainable.

Conclusions:

  • An inexpensive intervention effectively increased health care agent (HCA) documentation.
  • The study highlighted a critical need for regular updates to existing advance care planning (ACP) documents.
  • The intervention proved to be a sustainable method for improving ACP documentation practices.