Supporting meaningful advance care planning: A quality-improvement initiative to enhance number and preparedness of individuals selected as medical power of attorney.

Abstract

201 Background: Few health care organizations have successfully implemented a systematic process for meaningful advance care planning (ACP). An available and capable medical power of attorney (MPOA) allows early engagement in the process and is a foundation for successful ACP. As a first step, we implemented a quality improvement (QI) initiative to systematically offer patients (pts) an opportunity to select a MPOA that is valid*, incorporating quality measures to better prepare selected individuals for medical decision-making in a manner that supports the patient’s values and goals. Here we report on yield of valid MPOA documents (MPOAD) obtained. Methods: After QI Assessment Board approval was obtained, baseline data were collected for all head and neck medical oncologists (HNMO) over a 2-week period. In cycle 1, electronic health records (EHR) of pts seen by 2 HNMO were screened by clinic RN for MPOA. Those with MPOAD that were not available in EHR underwent RN follow up. All others were referred to social work (SW) for education regarding value of MPOA and factors important to preparation of decision maker. In cycle 2, revisions made to process included limiting targeted pts to new pts and consults (NPC). Results: See Table. Conclusions: Systematic SW contact and counseling increases the yield of valid MPOA, but is still insufficient for optimal results. Additional measures to be evaluated in future cycles include scheduled appointments for all NPC to increase SW contact, tighter follow up after initial SW contact and MD discussion with NPC to indicate importance of selecting a prepared MPOA. [Table: see text]