Health System Intervention to Innovate and Improve Advance Care Planning for Older Adults.

Abstract

Advance care planning (ACP) conversations happen infrequently even for patients with serious illness. Because patients are seen across settings, a unified approach to ACP is important in large integrated health systems. To describe the structural and clinical process changes implemented by a large health system to improve and expand ACP for older adults. UNC Health, a large academic public health system, created the ACP Taskforce to develop and implement a plan to document, facilitate, and educate to expand ACP across entities for patients 65 years and older. Between July 2019 to June 2022, the percentage of patients 65 years and older with any ACP documentation increased from 63% to 72.2%. ACP documentation shifted over that time to documenting health care decision makers and completing ACP notes. Aligning ACP across a large health system was facilitated by representation across entities and resulted in improved ACP practices.