• David Nowels, Molly A Nowels, Julia L Sheffler, Susan Kunihiro, and Hillary D Lum.
• From University of Colorado School of Medicine, Aurora, CO (DN, MAN, HDL); Rutgers University Institute For Health, Health Care Policy, and Aging Research, New Brunswick, NJ (MAN); Florida State University College of Medicine, Tallahassee, FL (JLS); Emory University School of Medicine, Atlanta, GA (SK); Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado (HDL). david.nowels@CUAnschutz.edu.
• J Am Board Fam Med. 2019 Nov 1; 32 (6): 835-846.

IntroductionPrimary care practices are essential settings for Advance Care Planning (ACP) conversations with patients. We hypothesized that such conversations occur more routinely in Advanced Primary Care/Patient Centered Medical Home (APCP/PCMH) Practices using practice transformation strategies.MethodsWe analyzed characteristics of physician respondents and their practices associated with ACP discussions in older and sicker patients using US data from the 2015 Commonwealth Fund International Survey of Primary Care Physicians in 10 Nations. The primary outcome was how routinely these ACP conversations are reported. We developed an index of APCP/PCMH features as a practice covariable.ResultsRespondents (N = 1001) were predominantly male (60%) and ≥45 years old (74%). Multivariable analyses showed that suburban practice location was associated with fewer ACP conversations; working in a practice commonly seeing patients with multiple chronic conditions or who have palliative care needs, and working in a practice from which home visits are made, were associated with more ACP conversations. Physicians compensated in part by capitation were more likely to report ACP conversations. No association was found between a single item asking if the practice was an APCP/PCMH and having ACP conversations. However, higher scores on an index of APCP/PCMH features were associated with more ACP conversations.ConclusionsIn this sample of US primary care physicians, the types of patients seen, practice location, and physician compensation influenced whether physicians routinely discuss ACP with patients who are older and sicker. Practices demonstrating more features of APCP/PCMH models of primary care are also associated with ACP discussions.© Copyright 2019 by the American Board of Family Medicine.

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