ArticleJournal of the American Geriatrics Society2025
Enhancing Advance Care Planning in Primary Care: A Three-Year Implementation Study in Nebraska.
Article in Journal of the American Geriatrics Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed.
- Enhancing Advance Care Planning in Primary Care: A Three-Year Implementation Study in Nebraska.Journal of the American Geriatrics Society · 2025Article
- Understanding attitudes and preferences towards advance care planning in older adults: Insights from a cross-sectional study in primary care.Palliative care and social practice · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
Abstract
backgroundDespite the benefits of discussing patients' preferences on care decisions, the uptake of advance care planning (ACP) in the U.S. is low. This study aimed to (1) identify barriers to ACP implementation, (2) implement two strategies (onsite ACP coordinator and Lightning Report facilitation-a rapid process improvement involving prompt feedback synthesis and timely action), and (3) track ACP outcomes (reach, implementation, and effectiveness).
methodsThis study took place at two primary care sites participating in the Nebraska Geriatric Workforce Enhancement Program from 2020 to 2023. We conducted a multi-stage evaluation mixed-methods study guided by the Practical, Robust Implementation and Sustainability Model (PRISM). Qualitative data from clinic staff interviews and focus groups were collected to identify implementation barriers, develop an optimal workflow, and educate providers and patients (implementation). Quantitative data from electronic medical records (EMR) were collected at baseline and every six months thereafter to assess ACP outcomes, including reach (patient-provider discussion of ACP) and effectiveness (ACP document completion). We mapped barriers to implementation strategies, mechanisms, and ACP outcomes based on PRISM domains.
resultsFrom 2019 to 2021, ACP outcomes remained consistent: Clinic A (reach: data not available; effectiveness: 20.5%-20.2%) and Clinic B (reach: 2.3%-2.6%; effectiveness: 1.8%-1.9%). After implementing the ACP coordinator and Lightning Report in 2022, moderate-to-high improvements were observed: Clinic A saw a 10-percentage point increase in reach (43.6%-53.6%) and a 2.5 increase in effectiveness (20.2%-22.8%). Clinic B experienced a significant 25.3-percentage point increase in reach (2.6%-27.9%) and a 16.5 increase in effectiveness (1.9%-18.4%). We also updated the clinic workflow to integrate the ACP initiative into standard practice (implementation).
conclusionsThe introduction of an ACP coordinator, along with the Lightning Report approach, may enhance ACP reach, effectiveness, and implementation in primary care settings for older patients.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.