Advance Care Planning Implementation in a Large Metropolitan Academic Medical Center: Challenges, Successes and...

Area of Science:

• Healthcare Management
• Medical Informatics
• Public Health

Background:

• Advance care planning (ACP) is essential for person-centered care but system-wide implementation in academic medical centers, especially with electronic medical record (EMR) integration, is not well-documented.
• Limited evidence exists on sustained, large-scale ACP program integration within complex healthcare systems.

Purpose of the Study:

• To detail the 10-year evolution of a multi-faceted ACP program at a major academic medical center.
• To report on key implementation outcomes and lessons learned from a decade of program development.

Main Methods:

• Implemented a comprehensive ACP program including dedicated management, EMR integration, and linkage with state registries (eMOLST).
• Utilized the Surprise Question for patient identification, interdisciplinary training, and patient-facing resources (website, webinars, telehealth).

Main Results:

• ACP note documentation for identified inpatients increased from 40% to 85% between 2018 and 2024.
• Clinical decision support reduced resuscitation order discordance from 32% to 23%.
• Gradual increase in ACP billing code utilization observed from 2020-2024.

Conclusions:

• A multi-component, data-driven ACP program can successfully integrate into institutional culture and workflows.
• Effective implementation improves documentation accuracy and order concordance, facilitating continuous quality improvement in advance care planning.