Concordance of Care with Goals of Care: Caring Through Conversations

An Advance Care Planning note (ACP note) was templated and introduced into practice at Mayo Clinic in August of 2015. The ACP note serves as an easily findable common location in the EHR for iterative review and documentation of individuals' values, preferences and priorities for health care. To describe the healthcare disciplines documenting the essence of goals of care conversations using the ACP note, the content of the ACP Note, and whether the content of the ACP note provides instructions to direct care. Secondly, to evaluate the concordance of care received to the documented values, preference and priorities of the patients in the ACP note. Lastly, to evaluate the utilization of hospice, the emergency room, and hospital services in a cohort of patients who died during the study timeframe. This was a descriptive retrospective EHR review study for all patients who had an ACP note within the first 7 months of the ACP note's existence. Three hundred and thirty-four ACP notes from 301 patients met study eligibility criteria. The majority of the ACP notes were written in the inpatient setting (56%) by physicians(56%). The ACP note was the only ACP document for 47% of our cohort. Concordance of care received with documented goals of care was 99.1%. Utilization of the hospital and emergency department were for goal concordant care. The ACP note has been widely adopted across our health system. Concordance of care received with documented patient goals of care is high.