Features of U.S. Primary Care Physicians and Their Practices Associated with Advance Care Planning Conversations

J Am Board Fam Med. 2019 Nov-Dec;32(6):835-846. doi: 10.3122/jabfm.2019.06.190017.


Introduction: Primary 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.

Methods: We 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.

Results: Respondents (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.

Conclusions: In 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.

Keywords: Advance Care Planning; Health Care Surveys; House Calls; Multimorbidity; Multiple Chronic Conditions; Palliative Care; Patient-Centered Care; Physician-Patient Relations; Primary Care Physicians; Terminal Care.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Advance Care Planning / economics
  • Advance Care Planning / statistics & numerical data*
  • Aged
  • Communication
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient-Centered Care / economics
  • Patient-Centered Care / statistics & numerical data*
  • Physician-Patient Relations
  • Physicians, Primary Care / economics
  • Physicians, Primary Care / psychology
  • Physicians, Primary Care / statistics & numerical data*
  • Practice Patterns, Physicians' / economics
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Primary Health Care / economics
  • Primary Health Care / statistics & numerical data*
  • Reimbursement Mechanisms
  • Surveys and Questionnaires / statistics & numerical data