An advance care planning long‐term care initiative in response to COVID‐19

March 6, 2021

Researchers from the IMPACT Collaboratory were among the team examining whether a systematic approach to address advance care planning (ACP) during a COVID-19 outbreak and its impact on the incidence of new do-not-hospitalize (DNH) directives among long-term care (LTC) residents. Susan L. Mitchell, MD, MPH and Sarah D. Berry, MD, MPH co-authored the publication in the Journal of the American Geriatric Society.

The prospective quality improvement initiative was set in two  long-term chronic care campuses within a large academic healthcare organization Participants included LTC residents with activated healthcare proxies who lacked DNH directives based on documentation in the electronic medical record (EMR) as of April 13, 2020. Using a structured discussion guide, trained healthcare staff from various disciplines contacted the residents’ proxies to conduct COVID-19 focused ACP discussions. Residents without DNH directives with COVID-19 were prioritized. Preferences ascertained in the discussion were communicated to the residents’ primary care teams and directives were updated in the EMR accordingly.

The authors found there was substantial opportunity to increase the proportion of LTC residents with DNH orders during the COVID‐19 pandemic through a systematic ACP initiative which utilized real‐time EMR data. New directives to avoid hospitalizations were sustained among the majority of residents beyond the peak of the pandemic.