HYBRID EVENT: You can participate in person at Orlando, USA or Virtually from your home or work.

6th Edition of Nursing World Conference

October 27-29, 2022 | Orlando, USA

October 27 -29, 2022 | Orlando, Florida, USA
NWC 2022

Amy Arlene Davis

Speaker at  Nursing World Conference 2022 - Amy Arlene Davis
Florida Southern College, United States
Title : Conversations to improve advance care planning for older adults in primary care: A pilot project


Advance care planning (ACP) necessitates important decisions regarding end-of-life health care. Current evidence suggests that ACP promotes concordance between the care desired and the care received by patients toward the end of life. However, only 30% of people in the United States have completed an advance directive or engaged in ACP. Health care providers in primary care settings are uniquely and favorably poised to provide information and education to help patients and families make informed end-of-life care decisions and document those decisions. Providers in these settings need evidence-based models and practices to achieve these objectives.

Purpose: The purpose of the Doctor of Nursing Practice capstone project was to improve ACP delivery and related outcomes for older adult patients at Medical Associates of Central Florida (MACF). The primary objective was to conduct a small-scale pilot project to examine the feasibility and short-term outcomes of an evidence-based clinical pathway for providing ACP services.

Methods: A pre and post-implementation quality improvement design was used. The intervention involved using the Conversation Project website to provide patients with a resource for self-directed learning and providing advance directives (AD) forms to participants. Pre- and post-implementation data were collected for older adult patients who completed a Medicare Wellness Visit (MWV) during the defined 90-day pre-and post-implementation periods.

Results:  Seventeen patients participated. The proportion of patients who completed ADs during the post-implementation period was higher when compared to the pre-implementation period (p = 0.0045). The rates for capturing AD-specific CPT billing codes and receiving payment for AD-related services were also higher during the post-implementation period (p = 0.00001 and 0.0011 respectively).

Conclusion: There were statistically significant increases in the number of ADs completed by patients who received education and resources to support AD planning. Capture and payment rates for AD-specific CPT codes (99497 and 99498) were also higher in the post-implementation period. 

Keywords: advance care planning, advance directives, living will, health care surrogate, primary care


Amy Davis is Family Nurse Practitioner currently practicing in Palliative Care. She is in the final semester of the Doctor of Nursing Program at Florida Southern College. She holds a Master’s of Nursing Degree from Florida Southern College and a Family Nurse Practioner national certification with the AANP. Amy Davis has been a seasoned registered nurse for over 20 years and an advanced practice nurse for the past four years. She has experience in acute care/hospital and primary care settings. In June 2022, she shifted her career to palliative care. Amy is an active member of the Polk County Advanced Practice Nurse Association (PCAPNA).