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Recognizing Quality Advance Care Planning Documentation: A Quality Improvement Initiative
Maria Teresa Cruz Carreras1, Mary Senkel1, Linda Luu1
1Department of Emergency Medicine, Critical Care, and Center for Goal Concordant Care, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Background:
ACP documentation in oncology emergency care frequently fails to capture patient values, reasoning, and voice, limiting its clinical utility.
Measures:
A five-domain ACP Documentation Quality Rubric (patient/family voice, goals/values, decision clarity, shared decision-making, plan integration) classified notes as Basic, Adequate, or Exemplary; the primary outcome was the proportion rated Exemplary.
Intervention:
Six components launched February 2026: provider education, exemplar dissemination, reviewer calibration, a point-of-care poster, unit champions, and formal kudos recognition of exemplary documentation.
Outcomes:
Exemplary documentation rose from 14.98% (49/327) at baseline to 21.54% (129/599) post-intervention, a 43.7% relative increase exceeding the 15% target (p=0.016); inter-rater reliability improved (weighted kappa 0.41 to 0.53).
Conclusions/Lessons Learned:
Standardized rubrics paired with peer recognition can measurably improve ACP documentation quality in a high-acuity oncology setting; sustainability and downstream patient outcomes warrant further study.
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