Sourcebook : 5.1 Review the Current Advance Care Planning Process : 5.1.1 Case Study - Dayton Veterans Affairs Medical Center

The Breakthrough Series team from the Dayton (Ohio) VA Medical Center aimed to increase to 95 percent the number of veterans, among those diagnosed with congestive heart failure, chronic obstructive lung disease, or lung cancer, who participated in advance care planning discussions. To measure progress, the Breakthrough Series team tracked advance care planning documentation by reviewing 50 randomly selected charts each week. Among the changes tested, the team:

• Redesigned a video on advance care planning for patients and families
• Revised and distributed a patient education booklet
• Developed discussion guidelines for providers and for follow-up
• Initiated an advance care planning clinic
• Revised the center's policy and bylaws on advance care planning and on hospice/palliative care, requiring them in certain circumstances
• Developed computer software to aid in advance care planning
• Initiated a bereavement support group

In a 12-week period, documentation of advance care planning discussions and follow-up increased from approximately 15 percent of charts to almost 90 percent.

The group established a clinic for advance care planning. In the course of a year, more than 150 patients and families have attended the clinics, which provide, in one hour, the following elements:

• An introduction and overview of advance care planning, including basic definitions, terminology, and review of handouts
• A 30-minute video, adapted and personalized for the Dayton VA's use, followed by a question-and-answer session
• Emphasis on the patient's right to control the decision-making process, to ask questions and have needs met
• Time to stay and complete forms
• An opportunity to take material home, including the video, in order to encourage other family members to become involved

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This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ www.abcd-caring.org ] and Oxford University Press. All rights reserved. For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ www.medicaring.org ].