Advance Care Planning Implementation in a Large Metropolitan Academic Medical Center: Challenges, Successes and Opportunities

BackgroundAdvance care planning (ACP) is a critical component of high-quality, person-centered care, supporting adults at any age or stage of health in discussing and documenting their preferences for future medical care. Evidence describing sustained, system-wide ACP implementation in large academic medical centers, particularly with electronic medical record (EMR) integration, remains limited.ObjectiveTo describe the design, implementation, and 10-year evolution of a multi-faceted ACP Program in a large metropolitan academic medical center, and to report key implementation outcomes and lessons learned.InterventionBeginning in 2014, the institution implemented a comprehensive ACP Program that included: creation of an ACP Program Manager role and enterprise-wide governance; integration of ACP into the EMR; linkage with the New York State electronic Medical Orders for Life-Sustaining Treatment (eMOLST) Registry and related clinical decision support; adoption of the Surprise Question to identify target patients; interdisciplinary training and online modules; and patient- and community-facing resources such as an ACP website, multilingual guides, webinars, and an ACP telehealth clinic.OutcomesAmong inpatients at the main campus hospital with a "no" response to the Surprise Question, ACP note documentation at discharge increased from 40% in 2018 to 85% in 2024. Clinical decision support reduced discordance between EMR and eMOLST resuscitation orders from 32% (N = 459) to 23% (N = 257). From 2020 to 2024, gradually increasing use of ACP billing codes were observed.ConclusionA multi-component, data-informed ACP implementation can embed ACP into institutional culture and workflows, improve documentation and order concordance, and support ongoing quality improvement.