The Implementation of a Comprehensive Advanced Care Planning (ACP) Program (QI736)

Abstract

1.Explain the importance of advance care planning (ACP) to our nation’s healthcare system and specifically how it affects end-of life care.2.Discuss our advance care planning hospital wide performance improvement project. A recent national survey found that about 90% of people say that talking with their loved ones about end-of-life care is important but about 27% have actually done so. Much of this care involves extremely aggressive measures to preserve life, resulting in higher costs and decreased patient/family satisfaction To create an Advanced Care Planning (ACP) system as an integral part of the health care routine and the community culture by facilitating conversations that help individuals and those close to them come to a clear and fuller understanding of their values, goals and treatment preferences. Over a two year period, we conducted three hospital wide trainings on having ACP discussions, developed educational materials including an informational video, improved workflow in the electronic medical record (EMR) to track discussions, education and documentation, and stressed use of billable codes for discussion to generate revenue. Initial preliminary data showed 24.76% of outpatients and 36.95% of inpatients had an advance directive in the EMR. This increased to 92% into the second year for outpatients. The improved EMR workflow to track discussion and education revealed that, at start of second year, 69% of inpatients had been asked about advance directives (“discussion”), 52% were provided information packet/shown educational video (“education”), and 15% of inpatients had an advance directive on file. Increased discussions are further revealed by steadily increasing revenue from billable discussions (CPT codes 99497 & 99498) with $4,693 at end of first year to $9,998 three months into second year. Training providers, distribution of educational materials to patients and improving workflows in the EMR resulted in increased ACP billable discussions. Examination of inpatient data suggests that increased discussions do not readily translate into documentation on file, suggesting cultural factors might affect actual completion of documents.