title: How healthcare systems evaluate their advance care planning initiatives: Results from a systematic review.
abstract: Advance care planning initiatives are being implemented across healthcare systems around the world, but how best to evaluate their implementation is unknown.
  
  
  
  To identify gaps and/or redundancies in current evaluative strategies to help healthcare systems develop future evaluative frameworks for ACP.
  
  
  
  Systematic review.
  
  
  
  Peer-reviewed and gray literature searches were conducted till February 2015 to answer: "What methods have healthcare systems used to evaluate implementation of advance care planning initiatives?" A PICOS framework was developed to identify articles describing the implementation and evaluation of a health system-level advance care planning initiative. Outcome measures were mapped onto a conceptual quality indicator framework based on the Institute of Medicine and Donabedian models of healthcare quality.
  
  
  
  A total of 46 studies met inclusion criteria for analysis. Most articles reported on single parts of a healthcare system (e.g. continuing care). The most common outcome measures pertained to document completion, followed by healthcare resource use. Patient-, family-, or healthcare provider-reported outcomes were less commonly measured. Concordance measures (e.g. dying in place of choice) were reported by only 26% of studies. The conceptual quality indicator framework identified gaps and redundancies in measurement and is presented as a potential foundation from which to develop a comprehensive advance care planning evaluation framework.
  
  
  
  Document completion is frequently used to evaluate advance care planning program implementation; capturing the quality of care appears to be more difficult. This systematic review provides health system administrators with a comprehensive summary of measures used to evaluate advance care planning and may identify gaps in evaluation within their local context.
authors.affiliation: Advance Care Planning Collaborative Research and Innovation Opportunities Program (ACP CRIO), University of Calgary, Calgary, AB, Canada.
authors.forename: Patricia D
authors.initials: PD
authors.lastname: Biondo
authors.affiliation: Advance Care Planning Collaborative Research and Innovation Opportunities Program (ACP CRIO), University of Calgary, Calgary, AB, Canada.
authors.forename: Lydia D
authors.initials: LD
authors.lastname: Lee
authors.affiliation: Advance Care Planning Collaborative Research and Innovation Opportunities Program (ACP CRIO), University of Calgary, Calgary, AB, Canada Department of Medicine, University of Alberta, Edmonton, AB, Canada.
authors.forename: Sara N
authors.initials: SN
authors.lastname: Davison
authors.affiliation: Advance Care Planning Collaborative Research and Innovation Opportunities Program (ACP CRIO), University of Calgary, Calgary, AB, Canada Departments of Oncology, Medicine, and Community Health Sciences, University of Calgary, Calgary, AB, Canada Jessica.simon@albertahealthservices.ca.
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Simon
mesh_terms: D032722:Advance Care Planning / Q000592:standards*; D006801:Humans; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D015397:Program Evaluation / Q000379:methods*; D011785:Quality Assurance, Health Care / Q000379:methods
keywords: Advance care planning; evaluation; healthcare systems; systematic review