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TOPLINE:

Advance care planning (ACP) strategies, such as adding ACP coordinators and using the Lightning Report Facilitation, improved patient outcomes in primary care clinics in Nebraska, with an increase noted in the reach of ACP discussions.

METHODOLOGY:

• Researchers conducted a mixed-methods study at two Nebraska primary care sites, focusing on two strategies of ACP implementation, namely, adding an onsite ACP coordinator and using the Lightning Report Facilitation approach, to identify implementation barriers and improve outcomes.
• They used the Practical, Robust Implementation and Sustainability Model to guide the implementation strategies in two primary care clinics that had a process of ACP in their annual wellness visit.
• Clinic A had a social worker who is an ACP champion with very limited time and primarily Black patients (59%) who mostly had public insurance. Clinic B lacked an ACP champion, had minimal social work support, and comprised 81% Latinx patients, with 42.1% uninsured in 2022.
• The Lightning Report Facilitation method was used for rapid qualitative data analysis and feedback synthesis to improve ACP outcomes. Qualitative data were collected through four cycles of interviews and focus groups that discussed ACP goals, barriers, and strategies, leading to action plans for the next cycle.
• Quantitative data were gathered from electronic medical records at baseline and every 6 months to measure ACP outcomes such as reach (the proportion of patients aged 65 years or older who approached for ACP discussion), effectiveness (the proportion of patients aged 65 years or older with completed ACP documentation), and implementation (the inclusion of an optimal workflow and development of tools to increase ACP awareness and the billing potential).

TAKEAWAY:

• Providers initially reported low self-efficacy in discussing ACP and a lack of awareness about ACP coordinators, which were addressed by integrating a referral process and developing patient education materials.
• From baseline in 2019 to 2021, ACP reach and effectiveness remained stable at clinic A (reach, data unavailable; effectiveness, 20.5% to 20.2%, respectively) and clinic B (reach, 2.3% to 2.6%; effectiveness, 1.8% to 1.9%).
• In 2022, after the implementation of ACP strategies, clinic A’s ACP reach increased by 10.0 percentage points (from 43.6% to 53.6%) and effectiveness increased by 2.5 percentage points (from 20.2% to 22.8%).
• During the same time, clinic B experienced a 25.3-percentage point increase in ACP reach (from 2.6% to 27.9%) and a 16.5-percentage point increase in effectiveness (from 1.9% to 18.4%).

IN PRACTICE:

“The findings of this study suggest that adding a part-time staff member (ACP coordinator) for ACP patient education and assistance, combined with the rapid process improvement tool (Lightning Report), may enhance ACP outcomes in primary care settings,” the authors wrote.

SOURCE:

The study was led by Jungyoon Kim, of the College of Public Health at the University of Nebraska Medical Center in Omaha, Nebraska. It was published online on April 16, 2025, in Journal of the American Geriatrics Society.

LIMITATIONS:

The study’s findings were based on two primary care clinics in Nebraska, limiting generalizability of the results to other settings. The qualitative data may have been biased due to the selection of providers, potentially not representing all clinic staff perspectives. The reliance on external funding for ACP coordinators raised concerns about sustainability of the intervention.

DISCLOSURES:

This study was supported by Bureau of Health Workforce and funded by the Health Resources and Services Administration of the US Department of Health and Human Services as part of an award, with no financial support from nongovernmental sources. The authors reported no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.