Quality Improvement Project: Advanced Care Planning in a Rural Family Practice Clinic




West, Lauren


0000-0002-6726-8381 (West, Lauren)

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Purpose: Advanced Directives are a crucial means of ensuring patient's autonomy at the end of life. However, despite their importance, studies have continued to find that they are significantly underused in the United States. This project determined the prevalence of patients with Advance Care Directives in a rural family practice clinic. The primary purpose of this project was to provide patients over age 65 with an educational resource discussing Advance Care Planning. Methods: Patients eligible for this study were identified by nursing staff during check-in for office visits. All patients over the age of 65 were deemed eligible to receive the intervention. The nursing staff then performed a chart review to determine if the patient already had an Advance Care Plan created within the last 5 years on file. The nursing staff briefly discussed code status and living wills with all patients. The patient then received a 2-page Advance Care Planning handout from the American Academy of Family Physicians. Results: During the study period, a total of 77 patients were eligible and 91% of them received the intervention. Of the patients who participated in the study 71% did not have an up-to-date Advance Care Plan already documented in the EMR. Conclusions: This project demonstrates the lack of documented Advanced Directives and the great need for Advance Care Planning education among those aged 65 years and older in rural family practices. Future interventions should involve adding flags in the EMR to help identify patients who lack an Advanced Directive, and to prompt the provider to discuss Advanced Care Planning. Further follow up in 1 year is necessary to determine the true impact of the quality improvement project.