Background Advance Care Planning (ACP) is being implemented by healthcare systems around the world, but there is no consensus on how to evaluate these initiatives.

Aim To identify gaps and/or redundancies in the current evaluative strategies used by healthcare systems and to help develop a framework for future ACP evaluation.

Methods A systematic search of peer-reviewed and grey literature to March 2014 was conducted to answer: “What methods have healthcare systems used to evaluate implementation of ACP?” Using the PICOS model, articles describing the implementation and evaluation of health system level ACP initiatives  were identified. Outcome measures were mapped onto a conceptual quality indicator framework based on the Institute of Medicine and Donabedian models of healthcare quality.

Results Thirty-nine of 841 articles were included; most reported on single parts of a healthcare system only (e.g. continuing care). The most common outcome measures pertained to document completion; patient-, family-, or healthcare provider-reported outcomes were less commonly measured. The conceptual quality indicator framework identifying gaps and redundancies in measurement is presented as a potential foundation from which to develop a comprehensive ACP evaluation framework.

Discussion Capturing the quality of care is lacking in current evaluative strategies, as is evaluation across multi-sector healthcare systems.

Conclusion International dialogue is needed to achieve consensus on a comprehensive ACP evaluation framework. This review provides healthcare systems a comprehensive summary of measures used to evaluate ACP and the conceptual framework developed will help identify gaps or redundancies in evaluation of local ACP initiatives.