Discussion and documentation of advanced directives

Measure Purpose: Engage patients to develop care directives for those with life-threatening illnesses

The numerator: Patients with a neurologic condition admitted to the hospital who have documentation of advanced directives presence and a health care proxy OR documentation of a conversation to determine advanced directives and a durable power of attorney during the course of admission.

is divided by

The denominator: Any adult patient with a primary neurologic diagnosis at the time of admission

Exclusions are removed from the denominator for:

• Patients with a new diagnosis at the time of admission
• Patients who are aphasic or otherwise unable to speak for self

Key Phrases

Key phrases you should document to meet the measure include:

• Advance directives and health care proxy discussed and documented
• Advance directives and health care proxy discussed
• Discussed advance directives and health care proxy

Measure Calculation Example

Dr. Brown had 50 patients on her hospital service between January 1 and December 31 of the measurement year. 12 patients had a new diagnosis at the time of admission. These 12 patients are removed from the denominator as exclusions.

Of the remaining 38 patients, eight had a discussion about advance care planning and determining a health care proxy. 

Quality of care = 8/(50-12). Dr. Brown has a score of 21% for this measure.