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Research Letter |

Incentivizing Residents to Document Inpatient Advance Care Planning

Joshua R. Lakin, MD1,3; Elizabeth Le, MD2; Michelle Mourad, MD3; Harry Hollander, MD4; Wendy G. Anderson, MD, MS1,3
[+] Author Affiliations
1Palliative Care Program, University of California, San Francisco
2Department of Medicine, Stanford University, Palo Alto, California
3Division of Hospital Medicine, Department of Medicine, University of California, San Francisco
4Division of Infectious Diseases, Department of Medicine, University of California, San Francisco
JAMA Intern Med. 2013;173(17):1652-1654. doi:10.1001/jamainternmed.2013.8158.
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Discussing preferences for care near the end of life increases the likelihood that patients will receive care consistent with their preferences.14 Recent work5 demonstrates that medical professionals infrequently ask about and document preferences for patients upon hospitalization. Because most end-of-life discussions occur in hospitals,6 we implemented a quality improvement program incentivizing resident physicians to consistently document key information about inpatient advance care planning discussions in a timely manner in an accessible location.

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Figure.
Percentage of Discharge Summaries With Required Documentation

Required documentation, completed within 48 hours of discharge, included whether the patient had expressed wishes for care and identified a surrogate decision maker. Dashed line indicates program target completion rate of 75%.

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