Pivoting to serious illness conversations to meet advance care planning quality measures in academic primary care clinics

Abstract

Purpose

As novel payment models incentivize advance care planning (ACP) in primary care, conversation-focused models of ACP that prioritize serious illness conversations (SICs), which focus on discussing patients’ understanding of their illness and their goals and values, can make meeting quality measures more clinically impactful.

Methods

We implemented the Serious Illness Care Program (SICP), an evidence-based ACP intervention, in academic primary care clinics. SICP supports healthcare systems to increase SICs through clinician training, coaching, and integrating a documentation module within the electronic medical record. Key facilitators of our implementation included adapting SICP training to accommodate primary care providers’ (PCPs) schedules, financial incentives for PCPs to complete SICP training and SICs, support of a physician ACP quality lead role, leadership support, and information technology collaboration.

Results

Throughout the 2023 and 2024 fiscal years, 59 of the 84 faculty PCPs (70%) in our primary care clinics completed SICP training. Of the SICP-trained PCPs, 41 (69%) completed at least one SIC. During the implementation, 340 SICs were documented for 238 unique patients.

Conclusion and implications

While additional work is needed to increase rates of PCPs completing SICs, we found that implementing SICP in academic primary care clinics is feasible when incentives, leadership support, and champions are in place.