A Practice Improvement Project to Increase Advance Care Planning in a Dementia Specialty Practice

Valerie T. Cotter, Maryam M. Hasan, Jheesoo Ahn, Chakra Budhathoki, Esther Oh

Research output: Contribution to journalArticlepeer-review


This study was conducted to enhance the rate of advance care planning (ACP) conversations and documentation in a dementia specialty practice by increasing physician knowledge, attitudes, and skills. We used a pre- and postintervention paired design for physicians and 2 independent groups for patients. The ACP dementia educational program encompassed 3 objectives: (1) to understand the relevance of ACP to the dementia specialty practice, (2) to provide a framework to discuss ACP with patients and caregivers, and (3) to discuss ways to improve ACP documentation and billing in the electronic medical record. A 10-item survey was utilized pre- and posteducational intervention to assess knowledge, attitudes, and skill. The prevalence of ACP documentation was assessed through chart review 3 months pre- and postintervention. The educational intervention was associated with increased confidence in ability to discuss ACP (P =.033), belief that ACP improves outcomes in dementia (P =.035), knowledge about ACP Medicare billing codes and requirements (P =.002), and belief that they have support from other personnel to implement ACP (P =.017). In 2 independent groups of patients with dementia, documentation rates of an advance directive increased from 13.6% to 19.7% (P =.045) and the Medical Order for Life-Sustaining Treatment (MOLST) increased from 11.0% to 19.0% (P =.006). The MOLST documentation in 2 independent groups of patients with nondementia increased from 7.3% to 10.7% (P =.046). Continuing efforts to initiate educational interventions are warranted to increase the effectiveness ACP documentation and future care of persons with dementia.

Original languageEnglish (US)
Pages (from-to)831-835
Number of pages5
JournalAmerican Journal of Hospice and Palliative Medicine
Issue number9
StatePublished - Sep 1 2019


  • advance care planning
  • dementia
  • palliative care

ASJC Scopus subject areas

  • Medicine(all)


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