Increasing Advance Care Planning Completion at an Academic Internal Medicine Outpatient Clinic.

BACKGROUND: We sought to increase advance care planning (ACP) completion at an academic internal medicine clinic through an electronic health record.

MEASURES: Number of eligible patients who completed a form of ACP.

INTERVENTION: Multidisciplinary team approach with engagement from providers and clinic staff; implemented informational letter and appropriate forms to eligible patients before appointment; informational video and provider reminders at time of appointment.

OUTCOMES: Of 480 eligible patients, 327 (68%) completed one or more forms of ACP or had a discussion with their provider. Discussed but not completed was highest (53%). The three types of ACP completed were 1) a state-formatted advance directive form (47%), 2) Medical Orders for Life-Sustaining Treatment (45%), and 3) power of attorney designation (8%).

CONCLUSIONS: Implementation of a multi-disciplinary approach can facilitate ACP. However, challenges still arise because in more than half of the cases, advance care efforts led only to a discussion.