| Description |
Background: Advanced care planning (ACP) is a proactive process that helps assure individual's values, preferences, end-of-life goals are identified, communicated, and honored throughout their entire lifespan. Nearly 75% of Americans do not have advanced directives (AD) that outline these preferences. Of all ACP completions, 17% occur in the primary care setting. Primary care providers report they lack the time, resources, education, and as a result often do not engage in ACP discussions with their patients. While 75% of Americans wish to die at home, an estimated 70% of them die in hospitals or other nursing-care facilities. The purpose of this quality improvement project was to provide a short video, to help future and current primary care providers facilitate advance care planning discussions. Methods: This project produced a free tool to assist primary care providers facilitate ACP with the patients. This project evaluated the following components: 1) ACP related knowledge; 2) integration of ACP related into professional practice 3) personal ACP completion rates; and 4) clinical ACP related practices assessed by the number of ACP discussions and reimbursement billings. Pre-intervention and one-month post-surveys were compared to identify differences in the participants' ACP-related knowledge, integration of ACP into professional practice, personal and clinical ACP practices. Results: Upon completion, participants' ability to identify the goal of ACP increased 4.1% and awareness of approved CPT or ICD-10 codes for ACP reimbursement purposes increased 33%. Perceived likelihood to initiate ACP with patients increased 111% (N= 19, 70.4%). Belief of the importance in discussing ACP with primary care patients increased 29.9%. Over 96% of participants reported a belief it is important to discuss ACP with their patients (N=26, 96.3%; M=2.96, SD=.19). There was a statistically significant finding associated with participant's willingness to integrate ACP into professional practice (p = .014) and to initiate ACP discussions in the primary cares setting (p = .001). Post-intervention, 29.6% of project participants (N=8) had completed their personal ACP, yet only three had discussed their ACP preferences with their PCP (M=1.63, SD=.51). All participants reported at least one of their significant others (SOs) knew they completed their personal ACP, yet two participants were unsure if one of their SOs could explain the details of the ACP preferences (25%, M=1.50, SD=.92). There were no changes noted with personal ACP practice change. Regarding clinical practice, over 22% of participants billed for CPT codes 99497 and/or 99498 codes in the month post-exposure (M=1.30, SD=.60). Clinical utilization of these ACP reimbursement codes increased 200%. Direct ACP interactions increased 12% as 66.7% of participants reported had led at least one ACP conversation with patients, this finding was significant (p = .016). Conclusions: An ACP educational video helped increase integration of ACP into participants' professional and clinical practices. Participants' personal ACP completion rates and practices aligned with current and historical national ACP-related data and research literature. PCPs desire and are committed to completing ACP-related education autonomously. Continued efforts are needed to improve future and practicing primary care providers' personal and clinical ACP awareness and practices. |
