Discussion and documentation of advanced directives
Measure Purpose: Engage patients to develop care directives for those with life-threatening illnesses
The numerator: Patients with a neurologic condition admitted to the hospital who have documentation of advanced directives presence and a health care proxy OR documentation of a conversation to determine advanced directives and a durable power of attorney during the course of admission.
is divided by
The denominator: Any adult patient with a primary neurologic diagnosis at the time of admission
Exclusions are removed from the denominator for:
- Patients with a new diagnosis at the time of admission
- Patients who are aphasic or otherwise unable to speak for self
Key Phrases
Key phrases you should document to meet the measure include:
- Advance directives and health care proxy discussed and documented
- Advance directives and health care proxy discussed
- Discussed advance directives and health care proxy
Measure Calculation Example
Dr. Brown had 50 patients on her hospital service between January 1 and December 31 of the measurement year. 12 patients had a new diagnosis at the time of admission. These 12 patients are removed from the denominator as exclusions.
Of the remaining 38 patients, eight had a discussion about advance care planning and determining a health care proxy.
Quality of care = 8/(50-12). Dr. Brown has a score of 21% for this measure.