Educational Interventions to Improve Advance Care Planning Discussions, Documentation and Billing.

The study was a before-and-after quality improvement project, not a randomised trial, and it did not report a control group. Practices chose which ACP measure to target, so the three outcomes were not studied in all clinics. Patients who declined ACP activities were not included, which may make the remaining group more receptive. All clinics were in central or southeastern North Carolina, and most were small independent practices, so results may not apply to large systems. Practices had existing relationships with consultants and self-selected ACP, so providers may have been more motivated than usual. Some site-level p-values were unadjusted for multiple comparisons, and only about half of practices achieved significant gains. The highest EMR documentation rate was 19%, so most patients still did not have ACP recorded.

The authors declared no potential conflicts of interest. The work was funded by HRSA/HHS through a Geriatrics Workforce Enhancement Program grant and supported by the Center for Aging and Health, Carolina Geriatric Workforce Enhancement Program. The sponsors had no role in design, methods, analysis, or manuscript preparation.

Do not read the rise in ACP discussions and EMR entries as proof that patients received better end-of-life care. The study measured conversations, documentation, and billing as proxies, not whether wishes were followed, and billed ACP encounters rose from 3.3% to 5.2% but did not increase significantly.