Grant: Partnerships for Health System Improvement (PHSI)

Our health care system is under siege- an aging population, patients living longer with chronic illness, and an increasing demand for services at end of life contribute to escalating costs. In a recent national survey, more than 80% of Canadians were concerned the quality of health care in Canada will decline as a result of increased strain on the health care system as our population gets older. Advance Care Planning (ACP) may offer some assistance with reducing health care costs for older Canadians and yet, at the same time, improving quality of care. ACP is the process by which a person considers options about future health care decisions and identifies their wishes. An advance care plan is a verbal or written instruction describing what kind of care an individual would want (or not want) if they are no longer able to speak for themselves. ACP has been shown to increase the quality of life of dying patients, improve the experience of family members, and decrease health care costs. To date, there has been no evaluation of the effectiveness of ACP from the perspective of patients and families. We need this information to guide successful implementation of ACP in our society at large and in hospitals specifically. In 10 hospital sites in BC and Alberta , we propose to conduct a prospective audit of current practice related to ACP in elderly patients at high-risk for dying and their families. The insights we gain from evaluating ACP can be used to improve the quality and quantity of ACP in Canada and thus, we have the potential to improve end of life care and reduce health care costs.