No abstract

Background: End-of-life discussions rarely begin early in a patient's disease course due to the time intensive nature of these conversations. Neglect of such conversations often results in poor understanding about a patient's care preferences. Electronic health record (EHR)-tethered Personal Health Records (PHRs) are being used more widely in chronic disease management and may provide a time efficient vehicle to embark on early end-of-life conversations, also known as Advance Care Planning (ACP).

Results Mean delta weight Z-score increased from À1.8 to À1.08 (figure 4) following the implementation of all of the noted interventions with centerline shift that has lasted for 8 months (40% improvement). Mean number of lactation consults ordered per week increased from 1 to 4. Conclusions Reducing nutrition practice variation shows marked improvements in infant nutrition status. We continue to test other interventions with the hope of further decreasing growth failure.