Advance Care Planning Bundle: Using Technical and Adaptive Solutions to Promote Goal Concordant Care.

Abstract

Background: Advance Care Planning (ACP) is critical to achieve goal-aligned care for patients. However, optimal implementation requires complex coordination and alignment across a healthcare system.

Measures: A survey of rapid response providers assessed usefulness of the ACP quality improvement bundle and perceptions of use and adherence.

Intervention: We implemented a bundle of advance care planning tools and interventions using the technical-adaptive framework. These included orders, documentation templates and processes, and standard education.

Outcomes: Ninety-three rapid response providers completed the survey. 80.5% reported that overall, these quality improvement efforts have been very helpful or somewhat helpful in improving their ability to provide care consistent with the patient's goals.

Conclusions/lessons learned: Implementation of technical and adaptive tools as a bundle for Advance Care Planning shows promise to improve and sustain goal-aligned care. Quality Improvement in ACP is a complex, iterative process involving both structural change and behavioral adaptation.