Blog | Monday, July 22, 2013

QD: News Every Day--Rewards get housestaff to record advance planning directives

A financial incentive to housestaff to improve documentation of advance planning directives increased advance care planning discussions to 90% of patients, a research letter reported.

Residents at the University of California, San Francisco, were offered a $400 incentive if they documented within 48 hours of discharge whether a patients wanted advance planning and who the surrogate would be. They had to document this for 75% of patients in three of four quarters of the year.

Results appeared online July 15 in a research letter at JAMA Internal Medicine.

A review of medical records of 1,474 patients (55.5%) discharged from the medical service showed that rates of documentation rose from 22.2% at the beginning of the program (July 2011) to more than 90% by October and remained near this level through the end of the program (May 2012). Rates in an attending-only service, which used the electronic template but did not receive the incentive, ranged from 0% to 50% with a yearly mean of 11.7%, the authors noted.

Researchers wrote, "We believe that the discharge summary template and the financial incentive program provided the foundation for the observed increase in documentation rates. However, rates did not begin to increase until we implemented and refined performance feedback, indicating that this aspect was essential."