Measure Information Form

Measure Set: Assisted Living Community (ALC)

Set Measure ID: ALC-04

Performance Measure Name: Advanced Care Plan/ Surrogate Decision Maker

Description: Residents who have documentation of an advance care plan or surrogate decision maker in their record.

Rationale: This measure addresses advance care planning as one facet of high-quality care for older adults. The aim of advance care planning is to ensure that care near the end of life aligns with the patient’s wishes (IOM, 2014). Advanced care planning is associated with improved health outcomes for older adults, including reducing hospitalizations, intensive care unit (ICU) admissions, and hospital and ICU lengths of stay (Brinkman-Stoppelenburg, 2014; Hall et al., 2011; Khandelwal et al., 2015; Martin et al., 2016). However, most older adults do not have advance care planning conversations with their clinicians even though there is consensus among diverse stakeholders that advance care planning is a key component of high-quality care (NQF 2006; IOM, 2014).

The intent of this measure is to promote advance care planning discussions and documentation of that discussion in the resident’s record. As people age, consideration should be given to their treatment wishes in the event that they lose the ability to manage their care. A large discrepancy exists between the wishes of dying patients and their actual end-of-life care. Advance directives (AD) are widely recommended as a strategy to improve compliance with patient wishes at the end of life, and thereby ensure appropriate use of health care resources at the end of life.

Type Of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: Residents who have an advance care plan or surrogate decision maker documented in their record or documentation that an advance care plan was discussed but the resident did not wish or was not able to name a surrogate decision maker or provide an advance care plan per month.

Included Populations:

Residents that declined to discuss an advance care plan or surrogate decision maker.

Excluded Populations: Not applicable
Data Elements:

Advanced Care Plan/Surrogate Decision Maker

Denominator Statement: Number of residents who are new to the assisted living community each month.

Included Populations: Not applicable
Excluded Populations: Not applicable
Data Elements:

New Resident

Risk Adjustment: No.

Data Collection Approach:

Denominator: The total number from the data element New Resident is the Denominator.

This number will be entered into the Direct Data Submission Platform (DDSP) tool.

Numerator: Count number of residents with a 'Yes' to the data element Advanced Care Plan/Surrogate Decision Maker ; the total number is the numerator.

This number will be entered into the Direct Data Submission Platform (DDSP) tool.

Example: You are abstracting cases for the month of March. On March 31st there are 4 new residents who moved into the assisted living community. Your denominator will be 4. When you look back through the 4 resident’s records, all 4 had documentation of an advanced care plan/surrogate decision maker present in the resident’s record or the resident refuses; this is the numerator.

Denominator = 4
Numerator = 4

Data Accuracy: None

Measure Analysis Suggestions: None

Sampling: No.

Data Reported As: Aggregate rate generated from count data reported as a proportion.

Selected References:

Brinkman-Stoppelenburg, A., Rietjens, J. A., & van der Heide, A. (2014). The effects of advance care planning on end-of-life care: a systematic review. Palliative Medicine, 28(8), 1000-1025.
Hall, S., Kolliakou, A., Petkova, H., Froggatt, K., & Higginson, I. J. (2011). Interventions for improving palliative care for older people living in nursing homes. Cohrane Database of Systematic Reviews, 3.
Institute of Medicine (IOM). (2014). Dying in America: improving quality and honoring individual preferences near the end of life. Washington, DC: The National Academies Press.
Khandelwal, N., Kross, E. K., Engelberg, R. A., Coe, N. B., Long, A. C., & Curtis, J. R. (2015). Estimating the effect of palliative care interventions and advance care planning on ICU utilization: a systematic review. Critical Care Medicine, 43(5), 1102-1111.
Martin, R. S., Hayes, B., Gregorevic, K., & Lim, W. K. (2016). The effects of advance care planning interventions on nursing home residents: a systematic review. Journal of the American Medical Directors Association, 17(4), 284-293.
National Quality Forum. (2006). A National Framework and Preferred Practices for Palliative and Hospice Care Quality. Washington, DC: National Quality Forum.

Original Performance Measure Source / Developer: Adopted from National Committee for Quality Assurance measure.

Measure Algorithm:

Measure Information Form ALC-04

Assisted Living Community Measures (v2023B)
Discharges 07-01-23 (3Q23) through 12-31-2023 (4Q23)