A recent study reveals that automated outreach strategies significantly enhance advance care planning (ACP) among patients with serious illnesses. The research, published in the Annals of Internal Medicine, highlights the effectiveness of staff-initiated contact in encouraging patients to complete essential medical documentation.
Dr. Neil Wenger, a professor of medicine at UCLA and the study’s senior author, emphasizes the importance of patients discussing their medical care preferences with family and healthcare providers. However, he notes that these conversations can be challenging, especially for primary care physicians who face time constraints due to other clinical responsibilities.
“Nearly everyone will become seriously ill at some time, and creating better structures to stimulate advance care planning means that people will be more likely to have earlier conversations leading to medical care aligned with goals,” said Dr. Anne Walling, co-author of the study.
Comparative Study Across University Health Systems
The study compared three different ACP interventions across health care clinics at UCLA, the University of California, San Francisco, and the University of California, Irvine. Approximately 8,000 patients participated, all of whom were seriously ill and had established relationships with primary care physicians within these university health systems.
The researchers focused on whether these interventions led patients to complete an advance directive at 12 and 24 months. The interventions included:
- A message through the patient’s electronic health record portal with a link to an advanced directive and a mailed message.
- The same elements as the first, plus a link to PrepareForYourCare.org for additional guidance.
- The previous interventions, supplemented by health navigator outreach for personalized assistance.
Results and Impact of Automated Outreach
After 24 months, the study found that 13.7% of patients in the first group, 12.7% in the second, and 19.8% in the third group completed an advance directive available in their electronic health record. This data underscores the effectiveness of automatic outreach in advancing ACP.
“Health systems can put into place an automated mechanism to promote advance care planning conversations between patients and doctors within the existent clinical workflow,” stated Dr. Wenger. “A health navigator can augment advance care planning conversations by contacting patients before their doctor visit.”
The addition of health navigator outreach proved more effective in promoting advanced care discussions than the other methods. However, the study’s authors caution that the results may not be universally applicable, as the research was conducted within three University of California health systems and lacked a control group.
Future Directions and Broader Implementation
Looking ahead, Dr. Walling suggests expanding the intervention to a broader patient demographic and other healthcare systems. “The advance care planning intervention can be a foundation on which to build more sophisticated conversations and decision-making,” she remarked.
This development follows a growing recognition of the need for structured ACP conversations, particularly as healthcare systems strive to align medical care with patient goals. The move represents a significant step toward integrating ACP into routine clinical practice, potentially setting a precedent for other institutions to follow.
As the healthcare landscape continues to evolve, the implementation of automated outreach strategies may serve as a critical tool in ensuring that patients’ medical care preferences are respected and documented, ultimately leading to improved patient outcomes and satisfaction.
