Background: Advance Care Planning (ACP) documents enable patients to receive medical care that aligns with treatment preferences and goals. Discussions regarding ACP in primary care are often inadequate due to patient and provider barriers. The lack of completed ACP documents leads to patient care goals not being addressed and ACP metrics not being met. Major themes in the literature demonstrated that multidisciplinary teams, workflow redesign, staff education, and the use of the Electronic Health Record (EHR) can aid in improving ACP discussion and documentation rates. Purpose: The purpose of this QI project was to improve the existing ACP processes for patients 50 years and older within our designated family medicine clinic by increasing discussion and documentation rates. Methods: The project was implemented in a family medicine clinic in an urban area over a 3 month time period. An ACP focused workflow was implemented defining specific roles and responsibilities for the team members. Pre and post intervention data was collected through the EHR dashboard for patients 50 years and older with and without existing ACP documents. Implementation: During staff meetings, clinic staff and providers were educated about new roles and responsibilities. The Making Choices Michigan Advance Directive form was made available to patients and providers. Staff addressed if a patient had an existing ACP and providers then discussed ACP with the patient. Both were documented in the EHR. The ACP form was given to interested patients to be filled out at home or in the office at a separate appointment with staff. Results: Project outcome goal of 30% increase in ACP discussion and documentation was not met. There was a slight increase in the percentage of 5.62%. No statistical change (p=0.16) was noticed when comparing pre-intervention rates of ACP CPT II code use, 1123F (80) and 1124F (41), with post-intervention CPT II code use, 1123F (66) and 1124F (26) after chi square test.
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