Disease burden is higher in the United States than in comparable countries. The Patient Self Determination Act of 1990 requires healthcare facilities to provide Advance Care Planning (ACP) information to all Medicare patients. The healthcare staffs’ (n=7) commitment to 3-days of ACP training increase ACP rates in the primary care setting. The Medicare Incentive Program is the platform for this initiative. This quantitative project used a valid and reliable pre and posttest design that consisted of 27 items on a Likert-scale. A 3.5-month chart audit (n=91) was conducted to assess the completion rate. Descriptive statistics was used to describe the demographic data.

The results of the two-tailed Wilcoxon signed rank test were significant based on an alpha value of 0.05, V = 0.00, z = -2.37, p = .018. There was a significant increase in the post-readiness to change average scores. A Mann Whitney test was used to analyze the statistically significant difference between the averages in two ACP types and electronic health record documentation (EHR). Staff did not always code (Mdn = 0.00) but they documented in the EHR (Mdn =1.00; 512.00, p = 0.003). ACP discussion was performed 63% of the time during Annual Wellness Visits (AWV), and there was a 49% increase in the EHR documentation. Trained staff are key stakeholders in guiding ACP conversations. They understand the barriers, impact, and consequences related to the lack of advance directives.

The purpose of this project is to look at the relationship between education about Autism Spectrum Disorder (ASD) and knowledge, attitudes and beliefs in adult primary care providers. The project addresses the transition challenges adults with ASD have in finding a primary care provider who is comfortable and competent with ASD. Education was provided to adult primary care providers in a multi-site primary care clinic in a large metropolitan city in the Southwestern United States. The Modified Knowledge/Attitudes/Belief instrument was used. A pre-test was administered prior to the education session, then a post-test and a one-month post-test were given afterward.

The results of the education program showed that attitudes and beliefs increased after the education and continued to increase more in the month following. Knowledge improved after the education session but declined after a month although scores were not back to the pre-education level. Primary care providers who receive education about ASD may be more comfortable in caring for this population and more likely to welcome adults with ASD into their practice. Education for primary care providers is key to improving health outcomes for adults with ASD.

Background and Purpose: The lack of an advance directive (AD) can predispose a person to an aggressive course of treatment despite their wishes. When AD’s are incomplete, the chances of unwanted procedures, such as tube feedings and repeated transitioning between nursing homes and hospitals often result in the risk of increased mortality and morbidity, especially for older adults. Making end-of-life decisions can improve the quality of death by allowing individuals to make decisions to die in a dignified manner. The purpose of this project was to improve AD completion rates by implementing “Five Wishes” (FW) into the admission process in a long-term care facility (LTCF).

Methods: The project took place on the skilled nursing units at a LTCF in Southwestern Arizona over a 2-month period of time. Twenty random charts were assessed before the start of the project to determine the residents AD status. Those 20 were then informed about FW’s and encouraged to complete one, along with all newly admitted residents to the skilled nursing units. Logs were used for data collection and each participating resident signed a HIPPA document. Descriptive statistics were used to describe the sample and outcome variables.
Outcomes Of the 20 current residents included in the quantitative chart assessment, 6 (30%) residents completed a FW’s document. Fifty residents were admitted during the project span and 21 (42%) of them completed FW’s.

Conclusions: The FW’s completion rates were lower than expected. None of the residents had an AD more detailed than a basic full code or do not resuscitate (DNR) status before being informed of FW’s. It is recommended that the facility social workers would have implemented the intervention to increase the likelihood of adherence.