FutureCare Directions: Empowering Patient Choices in a Free Clinic Setting

Introduction

Advanced Care Planning (ACP) is documentation that allows patients to provide their healthcare preferences in the event they become unable to make those decisions for themselves. This documentation includes the patient’s treatment goals, their preference for life sustaining measures, and designation of a healthcare proxy. ACP plays a crucial role to ensure patients receive the care that aligns with their values, while providing healthcare professionals with a guide on treatments. ACP also reduces the emotional burden and distress that can come with making unknown healthcare decisions for a family member. This allows them to focus on supporting their loved one rather than struggling with complex medical choices.

The primary goal of this quality improvement project was to assess the prevalence of existing ACP documentation among patients receiving primary care at a local free clinic in Anderson, SC. This patient population consists of uninsured patients, many who are experiencing homelessness and other marginalized groups. A second objective of this project was to implement initiatives and raise awareness among both the patients and the staff regarding importance of ACP, working to reduce the gap between underserved populations and those who are insured- who more frequently engage in ACP discussions during the annual wellness visits.

Methods

To assess the prevalence of ACP documentation, a retrospective chart review was conducted using Epic SlicerDicer. A total of 977 patients were identified as receiving primary care at the Anderson Free clinic. The initial step was to review patient records to determine how many already had existing ACP documentation.

The second step was to facilitate discussion surrounding advanced care planning. An Epic note template was created for providers to use during patient visits. This template was modeled after the Physician Orders for Scope of Treatment (POST) form. It included questions regarding patient preferences on cardiopulmonary resuscitation, medical intervention, nutritional administration, and a healthcare legal representative.

Results

To date, 313 charts have been reviewed out of the 977 identified patients. Of these, only four patients had some form of ACP documentation in place. The ongoing project has highlighted a clear disparity in ACP documentation among free clinic patients compared to insured populations. In addition to the continued data collection, the project has also implemented efforts aimed to increase awareness of ACP. Patients are provided with detailed information outlining the significance of ACP, what it is, and the options available for their preferences. These efforts are aimed to improve the discussion of ACP within the free clinic, ensuring patients can make informed decisions about the future of their healthcare regardless of their current insurance or socioeconomic status.