Difficult Conversations: A Quality Improvement Project for Advance Care Planning in Primary Care
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Authors
Taylor, Luisa
Issue Date
2020-05-16
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Abstract
Purpose: The purpose of this DNP project was to increase provider knowledge, skills, and attitudes about Advance Care Planning (ACP) and augment the number of ACP conversations between patients 65 and older, who had recently had their initial Welcome to Medicare or Initial Preventative Physical Exam (IPPE), and their medical providers in the primary care setting.|Background: ACP is the ongoing process in which a patient and their healthcare provider discuss goals or personal wishes at the end-of-life (EOL) or in a potential medical crisis. Benefits of ACP in the primary care setting are widely documented, however; providers cite lack of training and time as barriers.|Sample/Setting: Primary care providers in a clinic located in the Midwest.|Methods: The number of ACP conversations were assessed using a provider survey. This survey also assessed providers’ knowledge, skills, and attitudes toward ACP and EOL planning using a 5-point Liekert scale in each category. Education was provided in a staff meeting with providers only. At the conclusion, a handout was provided with key points including CMS reimbursement codes, talking points, and suggested resources. Providers were encouraged to continue the ACP conversation with recent IPPE visits. Survey was re-distributed to providers at another staff meeting 12 weeks post intervention.|Results: Pre-intervention data showed 85% of respondents inquired about ACP 0-5 times per week, with 5% discussing ACP 10 or more times (n=20). Following the intervention, 45% reported asking about ACPT 0-5 times, 27% reported asking 5-10 times, and 18% reported asking 10-15 times per week (n=11). Providers in this clinic felt they received ACP training and 85% stated they felt comfortable discussing ACP.|Conclusion: While the intervention showed an increase of ACP conversations in the clinic, the data was subjectively gathered due to lack of EMR integration. Further interventions are required to ensure providers discuss ACP with their patients following their IPPE visits.
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Creighton University
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Copyright is retained by the Author. A non-exclusive distribution right is granted to Creighton University