Quality Improvement Project: Advanced Care Planning in Rural Family Practice Clinics

Introduction: Advanced Directives ensure patient’s autonomy at the end of life. This project’s purpose was to assess the outcomes of integrating discussions in patients over 65 with an educational resource discussing Advance Care Planning (ACP) and analyzing the change over one year in a family practice clinic with intervention vs. a family practice clinic without intervention. Methods: Data was collected at two family practice clinics. In Fall 2021, patients at clinic 1 were provided patient education on ACPs and provided resource material. Clinic 2 did not have this intervention take place. All patients 65 years or older were eligible for this study. A chart review was performed on each patient during the study period to determine if an ACP had been created within the last 5 years. Results: During the study period, a total of 167 patients were eligible. 64 at B&W Healthcare and 103 at Family Health Clinic. At the clinic with intervention, 89% of the eligible patients had an updated ACP within the past 5 years in Fall 2022, compared to the 9.7% at the clinic lacking intervention. Conclusion: This project demonstrated how the lack of documented ACP and the need for ACP education among those 65 years and older in rural family practices can be addressed in primary care visits. Future interventions should involve EMR flags to identify those who lack an updated ACP. The goal of discussing ACPs is to have an ongoing conversation to exchange, deliberate, and clarify values and responsibilities. This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U1QHP28735. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the Health Resources and Services Administration or the U.S. Department of Health and Human Services.