Advance care planning and palliative care counseling for patients with dementia

Measure Purpose: engage patients and surrogate decision makers in advance care planning

The numerator:

(1) patients who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan

AND

(2) patients or their surrogate decision maker who received comprehensive counseling regarding ongoing palliation and symptom management, and end-of-life decisions within two years of initial diagnosis or assumption of care (See measure specification for complete definitions.)

is divided by

the denominator: all patients with dementia (See measure specification for complete list of qualifying diagnoses.)

There is an exclusion for this measure:

• Patients who at the time of intake had advanced dementia for whom there was no record of advance care planning or surrogate decision maker prior to their admission.

Key Phrases

Examples of key phrases you could use to meet this measure include:

• Advance care plan recorded
• Surrogate decision maker identified
• End of life care planning discussed

Measure Calculation Example

Dr. Ramirez sees 100 patients with dementia between January 1 and December 31. This is the denominator. Dr. Ramirez does not admit any new patients with advance stage dementia in the calendar year to meet the exclusion.

Dr. Ramirez records advance care plans for 50 of the 100 patients. Twenty patients declined to develop an advance care plan after discussion with Dr. Ramirez. Of those 70 patients, 55 had counseling on palliation and symptom management and end of life care planning. The numerator is 55; there are 55 patients who meet both numerator requirements.

Quality of patient care = 55/100. Dr. Ramirez has a score of 55% for this measure.