Table 3.
Secular Trends During This Multi-site Advance Care Planning Pragmatic Trial
| Secular Trend | UCLA | UC Irvine | UCSF |
|---|---|---|---|
| External Changes | |||
| COVID pandemic, clinics shut down with shift to telehealth | 3/2020 | 3/2020 | 3/2020 |
| EHR Related Updates | |||
| EHR ACP Activity rolled out to all patients | Started 10/2018 | Started 7/2020 | Started 1/2019 |
| Fillable AD pdf available for UCLA Health AD | Started 7/2020 | ||
| AD’s added to health maintenance module | Started 10/2020 | Started 7/2021 | Started 6/2021 |
| EHR Patient portal AD reminders instituted for the health system | Started 1/2021 | Started 2/2022 | Started 10/2021 |
| Ability to upload AD through patient portal and reviewed by Health Information Services | Started 4/2021 | ||
| Quality Improvement Programs | |||
| ACP intervention sent to primary care patients 65 and older without serious illness in study clinics | 4/2020 (Arm 1 intervention only to health system quality improvement effort) | Started 10/19 (PCORI intervention to all patients 65 and older without serious illness) | |
| ACP Quality Metrics provided to Oncologists as part of another QI effort | Started 10/2018 | ||
| Population defined “Meaningful ACP” from HER elements and created EHR dashboard as part of another QI effort | Started 1/2019 | ||
| Annual Wellness Visit Push for ACP | Started 4/2021 (nurse practitioners involved in preparing patients for the visits | Started 7/2022 | Started 7/2019 |
| Inpatient ACP intervention | Started 7/2020 (A “surprise” question added to documentation) | Started 7/2019 (education, dashboards, clinician training, incentives) | |
| Separate QI projects use PCORI intervention and study materials in non-PCORI clinics | 2/2021 (several primary care clinics) | 10/2021 (primary care) | Started 10/2019 (primary care and surgery) |
| ACP Integrated into Cancer Center Materials | Started 6/2022 | Started 1/2020 | |
| Clinician Education & Initiatives | |||
| Medicine resident ACP training | Annually | Annually | Annually |
| Clinician and staff outreach about ACP EMR changes and billing | 2/2018 | 9/2021 | Started 1/2019 |
| Additional Health system ACP Clinician Training | 4/2019 oncologists & social workers 7/2021 Bone Marrow Transplant nurse practitioners |
7/2019 Primary care | 4/2019 (4 hours offered to all primary care providers in study clinics) |
| Patient-Focused Interventions | |||
| ACP Group Meetings/Events for patients | Started 1/2019 | Started 1/2019 | Started 4/2019 |
| Notaries in clinic | 4/2019, shut down 3/2020 with COVID and staff transitions | ||
| Systemwide Healthcare Decisions Day Outreach | Started 4/2019 | Started 4/2019 | |
| Law student home visits for ACP | Started 4/2019 UCSF/UC Hastings Consortium on Law, Science & Health Policy | ||
| Social workers allowed to complete ACP visits | Started 7/2019 |
EHR = electronic health record, AD = advance directive, ACP = advance care planning