Sparrow Hospital, Lansing, MI
Reducing Disparity Through Advanced Care Planning

Background: Advanced care planning is a strategic objective of the health system, but the present residency curriculum lacks standardized education on leveraging an advanced care plan to manage patients with chronic conditions. Our aim was to integrate advanced care planning into routine care to decrease healthcare disparity, ensure the treatment patients receive is aligned with their goals and values, and improve management of chronic health conditions in the ambulatory setting.

Methods: We requested Epic data for all patients in the last 12 months with 2 or more admissions who have a Sparrow Family Health Center or Carefree Clinic PCP. We stratified the data by patient demographics and by patients with an advanced care plan and patients without. We conducted a preintervention survey with residents to assess their advanced care planning competency. We administered the Respecting Choices Person Centered Care Advanced Care Planning Facilitator curriculum and conducted a postintervention survey to reassess the residents’ advanced care planning competency.

Results: Significant improvement in all 9 domains resulted from providing standardized education regarding how to facilitate an advanced care planning patient visit. The measured competencies included knowledge of applicable laws, comfort in initiating an advanced care planning discussion with patients, and ability to answer questions and respond to uncertainty.

Conclusion: This project required minimal resources and was deemed as a valuable use of educational time by the residents. This pilot did not include faculty, so the next cycle will be faculty development. For continued project success, it is imperative that the faculty have the tools to provide support as we expand this project to include simulated and real visits with patients. The initial intervention brought significant improvement in the residents’ self-rated competency to perform an advanced care planning visit. The residents reported the need for practice in this skill to master competency, supporting expansion of this project.