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J Am Geriatr Soc. 2010 Jul;58(7):1249-55. doi: 10.1111/j.1532-5415.2010.02956.x.

A comparative, retrospective, observational study of the prevalence, availability, and specificity of advance care plans in a county that implemented an advance care planning microsystem.

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1
Gundersen Lutheran Medical Foundation, 1836 South Avenue, La Crosse, WI 54601, USA. bjhammes@gundluth.org

Abstract

OBJECTIVES:

To determine whether outcomes have changed over time for a managed, systematic approach to advance care planning (ACP).

DESIGN:

Retrospective comparison of medical record and death certificate data of adults who died over a 7-month period in 2007/08 with those of adults who died over an 11-month period in 1995/96.

SETTING:

All healthcare organizations in La Crosse County, Wisconsin.

PARTICIPANTS:

Five hundred forty adults who died in 1995/96 and 400 adults who died in 2007/08.

INTERVENTION:

A systematic ACP approach, Respecting Choices, collaboratively implemented in 1993 and continuously improved in subsequent years.

MEASUREMENTS:

Demographic and cause-of-death data were collected from death certificates. Type and content of any advance directive (AD), existence and content of Physician Orders for Life-Sustaining Treatment, and medical treatment provided at the location of death in the last 30 days of life were abstracted from the medical record.

RESULTS:

The recent data show a significantly greater prevalence of ADs (90% vs 85%, P=.02) and of availability of these directives in the medical record at the time of death (99.4% vs 95.2%, P<.001) than the data collected over 10 years ago. The new data suggest that quality efforts have improved the prevalence, clarity, and specificity of ADs.

CONCLUSION:

A system for ACP can be managed in a geographic region so that, at the time of death, almost all adults have an advance care plan that is specific and available and treatment is consistent with their plan.

[Indexed for MEDLINE]

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