{"id":40953,"date":"2025-08-01T07:00:59","date_gmt":"2025-08-01T11:00:59","guid":{"rendered":"https:\/\/www.ncqa.org\/?page_id=40953"},"modified":"2026-01-30T07:16:20","modified_gmt":"2026-01-30T12:16:20","slug":"advance-care-planning-acp","status":"publish","type":"page","link":"https:\/\/www.ncqa.org\/report-cards\/health-plans\/state-of-health-care-quality-report\/advance-care-planning-acp\/","title":{"rendered":"Advance Care Planning (ACP)"},"content":{"rendered":"<p><span class=\"TextRun SCXW197856186 BCX0\" lang=\"EN-US\" xml:lang=\"EN-US\" data-contrast=\"auto\"><span class=\"NormalTextRun SCXW197856186 BCX0\">The percentage of persons 66\u201380 years of age with advanced illness, <\/span><span class=\"NormalTextRun SCXW197856186 BCX0\">an indication<\/span><span class=\"NormalTextRun SCXW197856186 BCX0\"> of frailty or who are receiving palliative care, and persons 81 years of age and older who had <\/span><span class=\"NormalTextRun ContextualSpellingAndGrammarErrorV2Themed SCXW197856186 BCX0\">advance<\/span><span class=\"NormalTextRun SCXW197856186 BCX0\"> care planning during the measurement period.<\/span><\/span><span class=\"EOP SCXW197856186 BCX0\" data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559740&quot;:257}\">\u00a0<\/span><\/p>\n<h2>Why It Matters?<\/h2>\n<p><span data-contrast=\"none\">Advance care planning is a continuous process of conversation and documentation to align a patient\u2019s care and interventions with their beliefs, values and preferences, in the event they become unable to make those decisions. The Centers for Medicare &amp; Medicaid Services (CMS) describe advance care planning as a face-to-face service to discuss a patient\u2019s health wishes that may or may not include completing relevant documentation <sup>(1)<\/sup>.<\/span><span data-ccp-props=\"{&quot;335559738&quot;:240,&quot;335559739&quot;:240}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"none\">A number of documents may be completed as a result of the advance care planning conversation in order to capture a patient\u2019s wishes and goals for care. These documents are generally referred to as \u201cadvance directives\u201d and can include: Durable Power of Attorney for Health Care, living will, and combined directives. In addition to these documents, a patient may have a Physician Orders for Life-Sustaining Treatment, also referred to as Medical Orders for Scope of Treatment. A patient may also identify a surrogate decision maker to serve as their representative and decision maker in the event they cannot make decisions for themselves <sup>(2)<\/sup>.<\/span><span data-ccp-props=\"{&quot;335559738&quot;:240,&quot;335559739&quot;:240}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"none\">Although it is widely agreed that advance care planning is a critical part of patient care, only about 50% of older adults have engaged in advance care planning. Of those older adults, about one-third have documented their wishes and only 10%\u201320% discussed their wishes with clinicians <sup>(3,4)<\/sup>. A 2017 study found that 70% of providers indicated they only have advance care planning conversations with their patients experiencing advanced illness <sup>(5)<\/sup>. The benefits of advance care planning may only be realized if the care team has access to and follows the patient\u2019s advance care plan.<\/span><span data-ccp-props=\"{&quot;335559738&quot;:240,&quot;335559739&quot;:240}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"none\">Advance care planning can lead to decreased psychological distress and hospitalizations as well as improved end-of-life care, increased trust in providers and improved quality of life, and can facilitate hope. It has also been associated with increased knowledge about treatment options, documentation of advance care planning, patient-surrogate congruence, goal concordant care and compliance with patient wishes, among others <sup>(6,7,8)<\/sup>.<\/span><span data-ccp-props=\"{&quot;335559738&quot;:240,&quot;335559739&quot;:240}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"none\">Racial and ethnic minorities are less likely to engage in advance care planning. A 2018 study found that in 2014 the Non-Hispanic Black\/African American and Hispanic populations were less likely to engage in advance care planning than the non-Hispanic White\/Caucasian population <sup>(9)<\/sup>. Another study found that individuals living in neighborhoods with lower neighborhood social economic status (nSES) had lower odds of advanced care planning compared with individuals in neighborhoods with high nSES, with those in the lowest quintile having 29% lower odds <sup>(10)<\/sup>.<\/span><span data-ccp-props=\"{&quot;335559738&quot;:240,&quot;335559739&quot;:240}\">\u00a0<\/span><\/p>\n<h2><span data-teams=\"true\">Historical Results \u2013 National Averages<\/span><\/h2>\n","protected":false},"excerpt":{"rendered":"<p>The percentage of persons 66\u201380 years of age with advanced illness, an indication of frailty or who are receiving palliative care, and persons 81 years of age and older who had advance care planning during the measurement period.\u00a0 Why It Matters? Advance care planning is a continuous process of conversation and documentation to align a [&hellip;]<\/p>\n","protected":false},"author":45,"featured_media":0,"parent":733,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page.php","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-40953","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Advance Care Planning (ACP) - NCQA<\/title>\n<meta name=\"description\" content=\"Assesses children who turned 15 months old during the measurement year and had 0\u20136 well-child visits with a primary care physician during their first 15 months of life.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.ncqa.org\/report-cards\/health-plans\/state-of-health-care-quality-report\/advance-care-planning-acp\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Advance Care Planning (ACP) - NCQA\" \/>\n<meta property=\"og:description\" content=\"Assesses children who turned 15 months old during the measurement year and had 0\u20136 well-child visits with a primary care physician during their first 15 months of life.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.ncqa.org\/report-cards\/health-plans\/state-of-health-care-quality-report\/advance-care-planning-acp\/\" \/>\n<meta property=\"og:site_name\" content=\"NCQA\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/NCQA.org\" \/>\n<meta property=\"article:modified_time\" content=\"2026-01-30T12:16:20+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.ncqa.org\/wp-content\/uploads\/2021\/04\/NCQA_cmyk_tag.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"627\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:site\" content=\"@NCQA\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.ncqa.org\/report-cards\/health-plans\/state-of-health-care-quality-report\/advance-care-planning-acp\/\",\"url\":\"https:\/\/www.ncqa.org\/report-cards\/health-plans\/state-of-health-care-quality-report\/advance-care-planning-acp\/\",\"name\":\"Advance Care Planning (ACP) - NCQA\",\"isPartOf\":{\"@id\":\"https:\/\/www.ncqa.org\/#website\"},\"datePublished\":\"2025-08-01T11:00:59+00:00\",\"dateModified\":\"2026-01-30T12:16:20+00:00\",\"description\":\"Assesses children who turned 15 months old during the measurement year and had 0\u20136 well-child visits with a primary care physician during their first 15 months of life.\",\"breadcrumb\":{\"@id\":\"https:\/\/www.ncqa.org\/report-cards\/health-plans\/state-of-health-care-quality-report\/advance-care-planning-acp\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/www.ncqa.org\/report-cards\/health-plans\/state-of-health-care-quality-report\/advance-care-planning-acp\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/www.ncqa.org\/report-cards\/health-plans\/state-of-health-care-quality-report\/advance-care-planning-acp\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/www.ncqa.org\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Report Cards\",\"item\":\"https:\/\/www.ncqa.org\/report-cards\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Health Plans\",\"item\":\"https:\/\/www.ncqa.org\/report-cards\/health-plans\/\"},{\"@type\":\"ListItem\",\"position\":4,\"name\":\"State of Health Care Quality Report\",\"item\":\"https:\/\/www.ncqa.org\/report-cards\/health-plans\/state-of-health-care-quality-report\/\"},{\"@type\":\"ListItem\",\"position\":5,\"name\":\"Advance Care Planning (ACP)\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/www.ncqa.org\/#website\",\"url\":\"https:\/\/www.ncqa.org\/\",\"name\":\"NCQA\",\"description\":\"Measuring quality. 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