Disease specific advance care planning for heart failure patients: implementation in a large health system.

Purpose: This study evaluates the implementation of Disease Specific Advance Care Planning (DS-ACP) for heart failure patients in a large health care system. The DS-ACP model uses a trained facilitator to guide communication between patient and proxy regarding patient values and goals for treatment in worst-case scenarios, develop a disease specific documentation plan, and identify needed resources.

Methods: Referral and DS-ACP service delivery data were merged with electronic health record data. Process measures for implementation are described. Patients who participated in DS-ACP are compared with those who did not on demographics, medical characteristics, and outcomes such as inpatient readmissions, and hospice use among those who died. A chart audit was completed on a sample of patients to examine differences in advance care planning documentation between participants and nonparticipants.

Results: Nearly one third (31.8%) of the 1894 heart failure patients referred to DS-ACP participated. Referral method was associated with participation. A chart audit revealed 94.3% of those completing the DS-ACP process, had a health directive compared to 24.8% of noncompleters (p<0.001). Of the patients who died by the end of the study period (n=286), DS-ACP participants were more likely to have used hospice compared to nonparticipants (56% versus 37%, p=0.002).

Conclusions: These initial evaluation results indicate the DS-ACP model, previously tested in randomized trials, can be successfully implemented among heart failure patients in a large health care system. Results demonstrate the importance of referral method and show initial positive results for participation, improved documentation, and hospice use.