Written by: Center for Care Innovations

This case study was prepared by Kristene Cristobal of Cristobal Consulting, contracted evaluator for the Spreading Solutions That Work program.

Advance care planning is making difficult decisions about treatments and preferences for end-of-life care when a patient is relatively healthy and cognitively intact.

Without advance care planning, many older adults die in hospitals rather than at home, relying on aggressive treatments that can increase the length — and not the quality — of their lives. Although advance care planning can increase the use palliative care, lower medical expenditures at the end of life, and lower emotional distress among patients and their families, it is a challenging conversation for many primary care providers to broach. Additionally, safety net populations are less likely to undertake advance care planning because of a number of barriers including limited access to legal professionals, illiteracy, and distrust of medical institutions.

Olive View-UCLA Medical Center improved the frequency and quality of the advance care planning conversations by using a group visit model.