The Effects of Education and Process Development with Providers on Advance Care Planning in the Rural Primary Care Clinic

Abstract

Timely advance care planning (ACP) conversations, with a health care provider, can lead to better care and increased satisfaction for patient and family at the end of life. One rural health clinic had no formal plan in place to implement ACP conversations until presentation of a health crisis; limited ACP during the Medicare wellness visit; and no use of the ACP Current Procedural Terminology (CPT) codes. The purpose of this quality improvement project was to implement a process to improve ACP for persons age 65 and older in a rural health clinic. The Iowa Model of Evidence Based Practice to Promote Quality of Care was used to guide this project. All providers and frontline staff were surveyed about ACP to assess process barriers, comfort with initiating ACP, and learning needs. An education session on initiating ACP with patients age 65 and older during the initial or subsequent Medicare wellness exam and the use of new CPT billing codes for ACP occurred. After three months, the providers and frontline staff were surveyed about their comfort level with ACP and frequency of ACP CPT billing codes were determined. Survey results did not show an increased comfort level; however, the clinic implemented the use of the ACP packet and flow chart successfully, with 38% of the ACP packets being utilized. This resulted in two return visits for beginning ACP conversations. The implementation of the ACP packet and flow chart assisted to improve the process of ACP at one rural primary care clinic.