Increasing Health Care Agent Documentation in a Residency Clinic

Mariah Eggebraaten, MD; Janisha Manhas, MB, BCh, BAO; Zach Merten, MD; Donald Pine, MD; Teresa Quinn, MD; Deborah M. Mullen, PhD

WMJ. 2025;124(2):162-164

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ABSTRACT

Background: Health care agent (HCA) documentation as part of advance care planning (ACP) helps clinicians understand patient care wishes. This project aimed to habituate these conversations and increase documentation rates.

Methods: Workflow redesign and novel educational interventions were implemented. Patients aged 50 and older received an HCA education “blue sheet” at check-in as a discussion prompt.

Results: Of 968 visits, patients in 44% received the intervention and 4% added HCA documentation. Chart audits found that 69% of patients had outdated (older than 5 years) ACP/HCA documentation. Clinician and staff found the process helpful, important to patients, and sustainable.

Discussion: This inexpensive intervention increased HCA documentation and highlighted the need to update old ACP documents.

Author Affiliations: University of Minnesota Methodist Family Medicine Residency, St. Louis Park, Minnesota (Eggebraaten, Merten, Pine, Quinn); University of Minnesota, Department of Family Medicine and Community Health, Hospice and Palliative Medicine, Minneapolis, Minnesota (Manhas); University of Tennessee at Chattanooga, Gary W. Rollins College of Business, Management Department, Chattanooga, Tennessee (Mullen).
Corresponding Author: Deborah M. Mullen, PhD, University of Tennessee at Chattanooga, Gary W. Rollins College of Business, Management Department, Chattanooga, Tennessee, phone 952.212.9053; email deborah-mullen@utc.edu; ORCID ID 0000-0001-6345-2889
Funding/Support: This project was conducted in-kind. Financial support for Dr Mullen comes from a University of Minnesota Medical School grant to the residency program to assist with resident and faculty research.
Financial Disclosures: Dr Mullen, a former employee, is now a contracted research advisor and has been compensated for her work on the study design analysis, implementation support, and writing.
Previous Presentations: This material was presented virtually as poster at the Minnesota Academy of Family Practice (MAFP) Research Forum on March 5, 2022, and was accepted as a poster presentation at the American Academy of Family Physicians National Conference July 28-30, 2022, in Kansas City, Missouri.
Acknowledgments: The authors wish to thank Alison Schmitz, RN, for her assistance with this project, especially data entry.

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