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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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.