1. PDSA cycles

2. Your Clinic Project- Advance Directives/ MOST form
Per a study patients prefer discussion:
Initiated by MD(thought it’s the physicians responsibility to initiate it)
Early in patient-MD relationship
In outpatient setting while healthy
With diagnosis of life-threatening illness

3. BACKGROUND
Advance directive documentation is a compliant requirement for hospital based clinics by CMS, JACHO.
Physicians have no taring to have these difficult conversations.
There is no time to have these discussions in clinic
Different providers have different documentation rates
Every resident physician is required to do a QI project.

4. Aim statement
To increase the completion rate of advance directive documentation in resident led ambulatory clinics (Patient completed package and the file was scanned into EMR) by 10% by April.

5. What patients to select for the project?
Your sickest 5 patients – you all know them .
In other words > 65 years of age with multiple comorbidities and /or terminal disease

6. Plan your own intervention
Dedicate a complete clinic visit to discussion
Showing them a you tube video of a code
Giving them resources to read
Be Innovative ……….

7. Five Patients chosen By the resident
Meeting inclusion criteria
Resident choses the intervention
Write the intervention down in your PDSA sheet
Patient comes to clinic
Provider Discusses Advance Directives
Document why the patient is not willing to sign the form in a Separate PCP note.
Document that the form was filled form in a Separate PCP note with advance Directive discussion Title
Put the copy in the assigned folder to be scanned
Make a copy of the signed MOST form (Needs both yours and patients signature)
Patient agrees to fill the MOST form
Patient agrees to fill the MOST form
Yes No No
Patient leaves the clinic with the original form

8. Scan MOST form and VA form

12. Outpatient Advance Directive Discussion
I discussed advance directives with the patient in clinic today.
The MOST(Medical orders for scope of treatment are :
___ Completed and forwarded for scanning
___ Not completed due to
a) ___ Patient wants to defer at this time to discuss with family
b) ___ Patient does not want to discuss advance directive
c) ___ Patient already completed advance directives in another institution.
d) ___ Other reasons , Please elaborate ___________________________

13. STUDY /Measure
Number of forms that are scanned.

14. Question