UC Davis Health Expands Advance Care Planning Across System

Comprehensive approach increases ACP conversations and reduces disparities among non-English-speaking patients

Apr. 17, 2026 at 4:08am

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A ghostly, translucent X-ray photograph revealing the intricate internal structures of a human heart, conveying the fragility and complexity of the body.An intimate look at the inner workings of the human heart, a symbol of the personal, medical decisions at the core of advance care planning.Davis Today

UC Davis Health has made a substantial, system-wide commitment to improving how patients and providers engage in advance care planning (ACP) conversations. The health system developed a screening method to identify patients with serious illnesses, offered ACP discussions with trained social workers, and expanded access to linguistically and culturally appropriate ACP resources. As a result, UC Davis Health increased ACP conversations among adults age 65 and older from just over 10% to more than 70%, and reduced equity gaps among non-English-speaking patients by half.

Why it matters

Advance care planning is critical for aligning patients' goals and values with their medical care, but studies show that completion rates remain low due to barriers like inconsistent documentation and insufficient clinician education. UC Davis Health's comprehensive, multidisciplinary approach demonstrates how a system-wide effort can improve ACP engagement and ensure more patients receive care aligned with their preferences.

The details

UC Davis Health developed a screening method to quickly identify patients with serious illnesses and offer them ACP discussions with trained social workers. This led to higher ACP completion rates, increased palliative care involvement, and greater inpatient hospice enrollment. The health system also expanded access to linguistically and culturally appropriate ACP resources, translating materials into five additional languages and launching a new ACP website.

  • UC Davis Health increased advance care planning conversations among adults age 65 and older receiving primary care from just over 10% to more than 70%.
  • In a separate initiative, equity gaps among non-English-speaking patients were reduced by half.

The players

Nathan Fairman

A health sciences clinical professor in the Department of Psychiatry and Behavioral Sciences at UC Davis Health.

Connor Reilly

Project manager for quality and safety at UC Davis Health.

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What they’re saying

“For advance care planning to be truly effective, it must be an ongoing, iterative process. A system‑wide approach is essential - one that consistently identifies patients who need support with ACP and ensures resources are accessible and available across every care setting where patients are seen.”

— Nathan Fairman, Health sciences clinical professor

“Our clinicians and social workers are focused on proactively identifying patients who might benefit from extra support, rather than relying solely on patient‑initiated discussions. These targeted efforts have paid off, and we have been able to reduce the ACP completion gap among non‑English‑speaking patients by more than half.”

— Connor Reilly, Project manager for quality and safety

What’s next

UC Davis Health is now focused on deepening patient engagement and broadening the program's reach, including new digital tools within the MyUCDavisHealth portal to help patients prepare for ACP conversations, and exploring partnerships across the University of California Health System to share best practices.

The takeaway

UC Davis Health's comprehensive, multidisciplinary approach to advance care planning demonstrates how a system-wide effort can improve engagement and ensure more patients receive care aligned with their preferences, while also addressing equity gaps among non-English-speaking patients.