End of Life Care Planning in a Primary Care Practice: A Quality Improvement Project
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Authors
Bayne, Rebecca
Issue Date
2021-05-14
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Abstract
End-of-life care planning is beneficial in meeting the patient's choices during the final days of life. However, end-of-life discussions with those who are chronically ill have not been initiated by Primary Care Providers. Medicare provides payment for end-of-life conversations during Medicare wellness exams, but providers may be unaware that compensation is available to discuss these crucial decisions. The purpose of this project was to increase the frequency of end-of-life discussions being held between the providers, nurses, and their clients in the primary care setting by increasing provider knowledge and confidence level with these conversations. Specific aims were to determine if: 1) providing an educational session for the providers would increase the frequency of end-of-life conversations and 2) end-of-life conversations would increase the use of the ICD code designated for advanced directives. This project took place in a rural medical office located in Nebraska. Patients 65 years and older were being seen for their annual Medicare visits. A retrospective chart review was completed before initiating the study. An educational session and handout were provided to increase provider knowledge and confidence in discussing end-of-life planning with their patients. Providers completed a pre-quiz and post quiz to assess comfort level and knowledge. Before the intervention, the billing code for end-of-life discussion was not used. Its use was increased to 23 times during the project, indicating providers-initiated end-of-life discussions. Post-test scores indicated an increase in the provider's knowledge and confidence. This project demonstrated that, before the educational session, the end-of-life discussions were not being completed and billed appropriately. The educational session effectively increased the frequency of these conversions, and the increase in billing with the ICD code was evident.
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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