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

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

Research output: Contribution to journalArticle


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)
JournalAmerican Journal of Hospice and Palliative Medicine
StatePublished - Jan 1 2019


  • advance care planning
  • dementia
  • palliative care

ASJC Scopus subject areas

  • Medicine(all)

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