Evaluation of a quality improvement initiative to increase rates of advance directive conversation documentation in primary care

As life expectancy increases, long periods of comorbidity and low quality of life commonly precede death. Advance care planning within primary care settings is necessary to increase patient agency and prioritize personal wishes. This article disseminates a quality improvement initiative within a federally qualified health center. New procedures were developed to systematically track advance directive conversations using current procedural terminology codes. The systems change resulted in a substantial and sustained increase in advance directive conversation documentation. The increase was presumably due to the implementation of small-scale changes, providers' commitment to geriatric primary care, increases in appointment times, allocation of tasks across disciplines, availability of Spanish speaking staff and translated forms, and the change to record keeping that enabled codes to be easily captured and tracked in the electronic medical record. This work may inform future quality improvement efforts to boost advance care planning among underserved populations in diverse settings. (c) 2020 Elsevier Inc. All rights reserved.

Automated summary

With longer life expectancy, there is a growing concern over long periods of comorbidity and low quality of life before death. Advance care planning in primary care settings can increase patient agency and prioritize personal wishes. This study presents a quality improvement initiative in a federally qualified health center, which successfully implemented new procedures to track advance directive conversations and achieved substantial improvements.