Date of Award

4-2019

Degree Name

Nursing (D.N.P.)

Department

College of Nursing

First Advisor

Dianne Conrad DNP, RN, FNP-BC

Second Advisor

Patricia Thomas, PhD, RN, FACHE NEA-BC, ACNS-BC, CNL

Third Advisor

Iris Boettcher, MD

Abstract

Advance care planning (ACP) is an importance process of reflection and communication regarding one’s preferences for future health care (Hagen et al., 2015). Findings from research indicate that advance care planning supports patient autonomy, improves quality of end-of-life, and increases patient and provider satisfaction (Bischoff at al., 2013; Brinkman-Stoppelenburg et al., 2014). To promote advance care planning discussion, the Centers for Medicare and Medicare Services (2016) made a decision to compensate health care providers for face-to-face conversations regarding future treatment associated with serious illness, offering two new current procedural terminology billing codes for ACP. The Plan-Do-Study-Act model (AHRQ, 2018) was used to guide a multi-faceted implementation strategy, incorporating uncovering provider barriers, providing education, and clinical support tools to electronic health record optimization to promote quality documentation advance care planning services provided within a home based primary care (HBPC) program. This quality improvement project was developed following a prior doctoral project (development of a standardized protocol for ACP) which now exists at the practice (McCloskey, 2018). Provider documentation notes (n=72) were audited over a threemonth period post implementation to assess the protocol and the efficacy of the changes made to the current process for ACP. An overall audit of all patient’s ACP documents (n=580) revealed a statistically significant (p=<0.0001) positive change in the number of patients with valid durable power of attorney for health care (DPOAH) on file, as compared to the audit in 2018. Provider ACP notes were also audited over a three-month period to determine eligibility for ACP billing codes. These ACP notes represent 72 face-to-face encounters, a significant opportunity (108 RVUs, or $5,871) to highlight productivity and reimbursement.

Available for download on Tuesday, April 28, 2020

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