Table 2.

Summary of Intervention Components^*

Patient components

Pre- and postvisit reminder letters

“Planning Ahead” brochure and chapter in health maintenance “handbook” (in place prior to intervention and also available at control center)

Provider components

Presentations to medical and support staff by chief of internal medicine

“Desk book” with interaction scripts, responses to questions frequently asked by patients, and assessment tools for commonly occurring complicating problems (dementia, depression)

Organizational components

Health maintenance task checklist attached to extended health maintenance visit charts by clinic support staff (includes asking about advance directive)

Preprinted sticker to remind provider to reintroduce issue at subsequent visit

Enhanced availability of advance directives via scanning and storage on central computer

Reinforcement steps

Single follow-up visit to providers by research assistant

Weekly follow-up visits to support staff by research assistant

Monthly feedback by site of number of new advance directives collected

^*See text for details.