Advance Care Planning (ACP)

This measure assesses the percentage of adults 66–80 years of age with advanced illness, an indication of frailty or who are receiving palliative care, and all adults 81 years of age and older who had advance care planning during the measurement year.

Why It Matters?

Advance care planning is a continuous process of conversation and documentation to align a patient’s care and interventions with their beliefs, values and preferences, in the event they become unable to make those decisions. The Centers for Medicare & Medicaid Services (CMS) describe advance care planning as a face-to-face service to discuss a patient’s health wishes that may or may not include completing relevant documentation.¹

A number of documents may be completed as a result of the advance care planning conversation in order to capture a patient’s wishes and goals for care. These documents are generally referred to as “advance directives” and can include: Durable Power of Attorney for Health Care, living will, and combined directives. In addition to these documents, a patient may have a Physician Orders for Life-Sustaining Treatment, also referred to as Medical Orders for Scope of Treatment. A patient may also identify a surrogate decision maker to serve as their representative and decision maker in the event they cannot make decisions for themselves.²

Although it is widely agreed that advance care planning is a critical part of patient care, only about 50% of older adults have engaged in advance care planning. Of those older adults, about one-third have documented their wishes and only 10%–20% discussed their wishes with clinicians.^3,4 A 2017 study found that 70% of providers indicated they only have advance care planning conversations with their patients experiencing advanced illness.⁵The benefits of advance care planning may only be realized if the care team has access to and follows the patient’s advance care plan.

Advance care planning can lead to decreased psychological distress and hospitalizations as well as improved end-of-life care, increased trust in providers and improved quality of life, and can facilitate hope. It has also been associated with increased knowledge about treatment options, documentation of

advance care planning, patient-surrogate congruence, goal concordant care and compliance with patient wishes, among others.^4,6,7,8

Racial and ethnic minorities are less likely to engage in advance care planning.⁴ A 2018 study found that in 2014 the Non-Hispanic Black/African American and Hispanic populations were less likely to engage in advance care planning than the non-Hispanic White/Caucasian population.⁹ Another study found that individuals living in neighborhoods with lower neighborhood social economic status (nSES) had lower odds of advanced care planning compared with individuals in neighborhoods with high nSES, with those in the lowest quintile having 29% lower odds.¹⁰

Historical Results – National Averages

Advance Care Planning

This State of Healthcare Quality Report classifies health plans differently than NCQA’s Quality Compass. HMO corresponds to All LOBs (excluding PPO and EPO) within Quality Compass. PPO corresponds to PPO and EPO within Quality Compass.

Figures do not account for changes in the underlying measure that could break trending. Contact Information Products via my.ncqa.org for analysis that accounts for trend breaks.