How Integris Health boosted advanced care planning documentation

Around two-thirds of U.S. adults have not documented end-of-life medical care directives, but a new case study has found that Integris Health was successful in boosting documentation by 20 percentage points for patients over 65.

With the program in place, the health system reported 99 percent documentation for hospitalized patients and an increase from 30 percent to 50 percent for all patients over 65 years of age.

Nationwide, the average number of adults who have formally documented their care wishes is only around 37 percent, according to a study — and that percentage barely increases for patients with chronic health conditions, of which only 38 percent have completed such directives. 

These low percentages were the impetus behind Oklahoma City-based Integris Health's advanced care planning initiative. Two years ago, the health system implemented the program aimed at boosting inpatient and outpatient advanced care planning documentation. Using a three-pronged approach, the system: 

  1. Prioritized having direct conversations about advanced care planning with patients both in hospitals and clinic settings.

  2. Developed a code status advisory to prompt clinicians to enter accurate code statuses.

  3. Used a tool for clinicians to accurately document patients' care wishes in their own words.

"When we offer people their reality and ask them to hand back their values, they have something to say about who they are and how they want to be taken care of," Jessica Zan, BSN, RN, director of IT clinical applications for Integris Health, said in a statement. 

Although capturing patients' wishes in their own words may seem complicated from the outside, it is something Ms. Zan noted to case study authors that is "worth it."

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