Implementation of Advance Care Planning EMR Tool into an Outpatient Primary Care Clinic, a Multidisciplinary Approach (QI817)

Abstract

•Demonstrate effectiveness of educational sessions and social worker involvement regarding implementation of new EMR tool into a primary care clinic for ACP documentation.•Discuss implications of our project and future goals. The Care Alignment Tool (CAT) is an Electronic Medical Record (EMR) tool designed to enhance advance care planning (ACP) conversations and documentation in Canopy. The CAT guides providers through advance care planning by prompting questions regarding patient beliefs about their health, goals for future health states, and, if applicable, desires for end of life care. Providers can then document their conversations and the form is available as part of the patient's EMR. Under a centrally located tab, it can be easily accessed during any encounter and is easily modified if the patient's health circumstances, or wishes, change. ACP documentation remains a major challenge, with particular respect to communicating ACP goals across the spectrum of health care settings. One study demonstrated approximately 50.9% of patients aged 65 or older had documentation of preferences for ACP in the EMR; among these patients only 1/3 had a scanned document available. This allows disparity between patients’ desired preferences and their actual experiences at the end-of-life. Our goal was to increase utilization of the CAT for patients ages 65 and older at our home practice, Elizabeth Family Medicine, from January, 2016 until March of 2017. We employed the model for improvement methodology. Our interventions were two brief educational sessions for clinicians, as well as embedment of a clinical social worker at the practice specifically for ACP discussions and aide. A monthly report of CATs performed was used to collect out data. Pre-intervention: 10 total CAT completed during 12 months CAT was available to providers. Post-intervention: Over 3 months, a total of 22 CAT were completed. We observed a meaningful increase in CAT utilization after implementation of our collective outpatient-directed intervention. These results not only indicate a successful implementation of CAT into an outpatient primary care setting, but shows that simple interventions utilizing multiple disciplines can have a profound impact.