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The Blog to Transform Advanced Care

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New Report Explores Best Practices for Promoting Use of Advance Care Planning

Supporting provider education, building coalitions, and addressing social determinants of health are just some of the practices that could boost the use of advance care planning (ACP), a new report finds.

Conducted by health care consulting firm Discern Health, the research was designed to help further develop the Coalition to Transform Advanced Care’s Advanced Care Transformation IndexSM. The ACT IndexSM assesses the overall performance of the advanced illness care movement over time based on a variety of measures, including the use of advance care planning. This is a key component of C-TAC’s efforts to ensure that people with advanced illness receive high-quality, person-centered care. The Executive Summary of this research is available here and the full report will be published in October 2019.

Advance care planning conversations help individuals share their goals, preferences and values to ensure that their wishes are honored by health care providers in the event that they are unable to speak for themselves. Studies published by the Journal of the American Medical Association and the Journal of Palliative Medicine have found that advance care planning can increase patient and family satisfaction while reducing the costs associated unnecessary or unwanted treatment.

“Advance care planning plays a crucial role in ensuring that people with advanced illness receive the care they want in the setting that is right for them,” said C-TAC Strategic Advisor Lou Gagliano. “Measuring ACP usage is central to our Index, and this research will help us provide a roadmap that can be used to improve advanced illness care on the state level.”

Through a literature review and environmental scan, researchers sought evidence on factors affecting ACP and actions that can be taken on the state level, along with other indicators that could impact the use of ACP. Researchers then analyzed the association of key driving factors with 2017 rates of ACP use at the state level.

Interviews were also conducted in order to identify best practices for increasing ACP use. Researchers spoke with stakeholders in Hawaii, the highest performer on the ACT indexSM ACP measure, as well as Louisiana, which showed lower rates of ACP. As a result of these interviews, C-TAC is recruiting Regional IndexSM Coaches in these two states, who currently lead grassroots work on the local level to improve advanced illness care and will share their expertise with others interested in improving ACP.

Best practices identified by researchers fell into several categories. In the area of patient education and resources, researchers advised using storytelling as a component of interventions and conducting outreach outside of health care settings.

On communication and accessibility, the report emphasized a need to make materials available in multiple languages and be aware of the racial and economic disparities in ACP, as well as cultural considerations, when designing new initiatives.

Educating providers on advance care planning early in their careers and offering ongoing reinforcement are other key practices, researchers found. This could involve holding training programs that illustrate the value of ACP and offer guidance that will help providers lead these conversations. The report also identified incentivizing providers to have ACP conversations, either through reimbursement or quality bonuses, as a best practice for increasing ACP use on the state level.

There are also legislative channels for increasing the use of ACP across states, the report suggests. Researchers encouraged supporting the passage of state policies that aid family caregivers, as well as those which promote person-centered care.

“We consider this research to be a starting point in an ongoing conversation about how to not only increase the practice of advance care planning, but also improve the quality of ACP conversations and ultimately the experience of people with serious illness.” said Discern  Health Director, Theresa Schmidt, “Many innovative approaches to ACP are underway across the United States, and we hope this report sparks debate, discussion, and collaboration.”

The full report will be available on the C-TAC website in October 2019. To learn more about the Summit, please click here.

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