Gerontology and Geriatrics Education

Background Advanced Care Planning (ACP) is an ongoing process to ensure patient wishes for end-of-life care are respected. Medicare now reimburses primary care practices for ACP. Methods The UNC School of Medicine’s Division of Geriatric Medicine’s Geriatric Workforce Enhancement Program partnered with the South East Area Health Education’s Practice Support teams (SEAHEC) to increase ACP activities. ACP activities were measured in three ways:the number of conversations providers have with patients, the frequency of billing for ACP, and the completion of ACP documents. SEAHEC assessed electronic health records’ (EHR) capabilities, reviewed practice workflows, and designed and delivered educational materials. Materials included guides for practice managers and clinicians, monthly newsletters and video training. Seventeen practices with 37 providers participated. Data is reported on 14 practices. Results Following the intervention: Seven practices increased the number of ACP conversations from an average of 25% of patients to 55%. (Range 1% to 45% pre-intervention and 4% to 98% post intervention) Four practices increased the percentage of patients who have completed written Advanced Directives that are then scanned into the EHRs from an average of 8% to 12%. (Range 0% to 13% pre-intervention and 6% to 19% post intervention) Three practices improved their billing rate from an average of 1% of patients to 8%. (Range 0% to 13% pre-intervention and 4% to 98% post intervention) Conclusion Continuing education and quality improvement coaching supported by available reimbursement through Medicare can engage providers in improving rates of ACP conversations, billing and completion.