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Increasing Advance Care Planning in Primary Care Practices: a Multi-site Quality Improvement Initiative

  • Marie B. SandovalEmail author
  • John G. King
  • Vicki Hart
  • Allen B. Repp
Concise Research Reports

INTRODUCTION

Problem Description

Advance care planning (ACP) is the process by which a patient, in consultation with their health care provider and loved ones, makes decisions about how to direct possible future health care in times of incapacity.1, 2 Primary care providers (PCPs) frequently offer longitudinal care to patients across years and are well positioned to discuss ACP with their patients.2, 3, 4 However, ACP has not been integrated into most primary care practices, and ACP rates among patients in many primary care practices remain suboptimal.5, 6

Specific Aims

We sought to develop and implement standardized processes to address common barriers and integrate ACP into daily practice across nine primary care clinics. Our specific aim was to increase the percentage of our adult primary care patients who had an ACP form in their electronic health record (EHR).

METHODS

Context

This project was performed in the four outpatient General Internal Medicine (GIM) and five Family Medicine...

Notes

Acknowledgements

The authors would like to acknowledge the cooperation and efforts of the participating staff, nurses, advance practice providers, physicians, administrative leaders, information technology staff, and Community Health Team members. Additionally, we sincerely appreciate the collaboration and support of the Vermont Ethics Network leadership.

Prior Presentations

We presented an earlier version of the manuscript as a plenary at the North American Primary Care Research Group (NAPCRG) conference in Montreal, Canada, on November 22, 2017, and the IPrACTISE conference in Madison, WI, USA, on April 11, 2017.

Compliance with Ethical Standards

The project received a “not research” determination from the University of Vermont Institutional Review Board.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

References

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    Committee on Approaching Death. Addressing key end of life issues; Institute of Medicine. Dying in America: improving quality and honoring individual preferences near the end of life. Washington (DC): National Academies Press (US); 2015.Google Scholar
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    Munday D, Dale J, Murray S. Choice and place of death: individual preferences, uncertainty, and the availability of care. J R Soc Med. 2007;100:211–15.CrossRefGoogle Scholar
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    Michiels E, Deschepper R, Van Der Kelen G, et al. The role of general practitioners in continuity of care at the end of life: a qualitative study of terminally ill patients and their next of kin. Palliat Med. 2007;21:409–15.CrossRefGoogle Scholar
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    Ramsaroop SD, Reid MC, Adelman RD. Completing an advance directive in the primary care setting: what do we need for success? J Am Geriatr Soc. 2007;55:277–83.CrossRefGoogle Scholar
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    Lund S, Richardson A, May C. Barriers to advance care planning at the end of life: an explanatory systematic review of implementation studies. PLOS One. 2015;10:e0116629.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Marie B. Sandoval
    • 1
    • 2
    Email author
  • John G. King
    • 3
  • Vicki Hart
    • 4
  • Allen B. Repp
    • 1
  1. 1.Department of MedicineThe Robert Larner, MD College of Medicine at The University of VermontBurlingtonUSA
  2. 2.Adult Primary Care-South BurlingtonSouth BurlingtonUSA
  3. 3.Department of Family MedicineThe Robert Larner, MD College of Medicine at The University of VermontBurlingtonUSA
  4. 4.Hart Dataworks LLCBurlingtonUSA

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