UC Davis Health earns 2023 Quality Leaders Award for Advance Care Planning Initiative

The California Health Care Safety Net Institute (SNI) and the California Association of Public Hospitals and Health Systems (CAPH) awarded UC Davis Health with the prestigious 2023 Quality Leaders Award (QLA) for its entry “Advance Care Planning and Mandatory Surprise Question” in the Population Health category.

The Quality Initiatives and Reporting team submitted the initiative.

“UC Davis Health initiated a comprehensive effort to enhance Advance Care Planning (ACP) in both inpatient and ambulatory settings, introducing the predictive Mandatory Surprise Question (MSQ) as a triage tool in January 2020,” Chief Quality Officer Gregory Maynard wrote in the submission. “MSQ+ (admitting providers who said they would not be surprised if a patient passed away in six months) patients exhibited a six-fold higher mortality rate, more palliative/hospice referrals, longer stays, and increased ICU admissions.”

2023 QLA: UC Davis Health from CAPH/SNI on Vimeo.

Following the results of the introduction of the triage tool, UC Davis Health deployed a social work-based advance planning intervention for MSQ+ patients in the Hospitalist Division.

“By fostering proactive ACP discussions, it significantly improved end-of-life care, showcasing UCDH's dedication to enhanced patient outcomes through innovative interventions,” added Advance Care Planning Medical Director Nathan Fairman.

The team first implemented the MSQ tool into the admission process. Then the team analyzed the MSQ to assess the accuracy of the initiative. Finally, the initiative identified patients who could benefit from ACP counseling, and it increased the number of UC Davis Health patients with completed ACP documents.

Fairman said that by providing additional support for advance care planning conversations, patients received treatment that better aligned with their wishes and values, and reduced feelings of helplessness and anxiety.

“We are impressed with UC Davis Health’s above-and-beyond approach to enhancing Advance Care Planning,” said Giovanna Giuliani, SNI’s executive director. “This program is a great example of how our public health care systems innovate to identify unique solutions and prioritize patient-focused approaches to improve community health.”

Since its pilot in February 2021, the MSQ Initiative’s social work intervention has expanded to include follow-up ambulatory ACP counseling and has been embedded as a routine part of primary care.

The team behind the submission received the award in person on Dec. 7 at the California Association of Public Hospitals and Health Systems Annual Conference in Long Beach, Calif.