Improving advance care planning in an age friendly health system

ABSTRACT

Background: Advanced Care Planning (ACP) is a complicated process that allows patients to make decisions about their future medical care that are consistent with their values. Documentation of patient's values should be done routinely and revised with change in the medical condition, this allows for their voice to be heard when they are no longer able to choose. We recently instituted addressing elements known as 4Ms (What matters, medication, mentation, and mobility) into our daily clinic flow as part of our certification to become an Age Friendly Health System1. This clinic-based QI project aims to assess the effect of the 4Ms process on ACP completion. Methods: We used a retrospective chart review and an electronic health record (EHR) generated report that compared patients seen in our office in 2 six-month periods;before (Jan-Jun, 2020) and after (Jul -Dec, 2020) instituting 4M care into our practice to assess its effects on our ACP completion rate. This QI project was conducted at our Geriatric Care Clinic, an outpatient clinic with a multidisciplinary team including physicians, pharmacists, nurses, and medical assistants. Our clinic used a checklist form as part of the rooming process that included all elements of the 4Ms. This project looked at the effect of addressing what matters most on ACP completion and documentation rates. We reviewed ACP documentation in the EHR that includes Living Will, Advance Directive, Power of Attorney, Five Wishes, to populate a completion rate. Results: We anticipate an increase in our ACP completion rate. Conclusions: We anticipate that there should be an improvement in our ACP completion rates after instituting 4M screening procedures. We recognize that our results may be complicated by changes in ACP discussion practices as they relate to differences in care during the COVID-19 pandemic. instituting 4M screening practices may be a useful process to improve ACP discussion and documentation.