title: A comparative, retrospective, observational study of the prevalence, availability, and specificity of advance care plans in a county that implemented an advance care planning microsystem.
abstract: OBJECTIVE
  To determine whether outcomes have changed over time for a managed, systematic approach to advance care planning (ACP).
  
  
  METHODS
  Retrospective comparison of medical record and death certificate data of adults who died over a 7-month period in 2007/08 with those of adults who died over an 11-month period in 1995/96.
  
  
  METHODS
  All healthcare organizations in La Crosse County, Wisconsin.
  
  
  METHODS
  Five hundred forty adults who died in 1995/96 and 400 adults who died in 2007/08.
  
  
  METHODS
  A systematic ACP approach, Respecting Choices, collaboratively implemented in 1993 and continuously improved in subsequent years.
  
  
  METHODS
  Demographic and cause-of-death data were collected from death certificates. Type and content of any advance directive (AD), existence and content of Physician Orders for Life-Sustaining Treatment, and medical treatment provided at the location of death in the last 30 days of life were abstracted from the medical record.
  
  
  RESULTS
  The recent data show a significantly greater prevalence of ADs (90% vs 85%, P=.02) and of availability of these directives in the medical record at the time of death (99.4% vs 95.2%, P<.001) than the data collected over 10 years ago. The new data suggest that quality efforts have improved the prevalence, clarity, and specificity of ADs.
  
  
  CONCLUSIONS
  A system for ACP can be managed in a geographic region so that, at the time of death, almost all adults have an advance care plan that is specific and available and treatment is consistent with their plan.
authors.affiliation: Gundersen Lutheran Medical Foundation, 1836 South Avenue, La Crosse, WI 54601, USA. bjhammes@gundluth.org
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Hammes
authors.forename: Brenda L
authors.initials: BL
authors.lastname: Rooney
authors.forename: Jacob D
authors.initials: JD
authors.lastname: Gundrum
mesh_terms: D022126:Access to Information; D000328:Adult; D032722:Advance Care Planning / Q000458:organization & administration*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005568:Forms and Records Control / Q000458:organization & administration; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D016414:Resuscitation Orders; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013597:Systems Analysis; D055815:Young Adult