Improving Incidence of Code Status Documentation Through Process and Discipline

Abstract

Documentation of a patient's preferred code status is a critical outcome of advance care planning. Although there is agreement that code status is valuable information, little progress has been made to increase the incidence of documented code status within the medical record in an outpatient setting. Incidence of code status documentation in the community oncology setting has not been studied. In April 2013, the US Oncology Network and McKesson Specialty Health launched a new advance care planning initiative for the purpose of promoting conversations between clinicians and patients regarding end-of-life care preferences. The program-My Choices, My Wishes-provides a systematic approach for learning about and documenting a patient's values and goals for care in the electronic health record. Code status documentation is one of several program performance measures. During the 14-month period from August 1, 2013, through September 30, 2014, collective sites participating in My Choices, My Wishes included discrete code status documentation within the medical record for 5,467 patients with metastatic disease. Although much work remains, early results show promise for improvement in incidence of code status documentation within health records in the outpatient setting.

Goals-of-care discussions

“…22 In another US Oncology study, Neubauer and colleagues reported that the implementation of an ACP process at 38 member sites resulted in a 15.6% increase in the incidence of code status documentation, and although the incidence of documentation varied considerably, it was as high as 89% at some sites. 23 …”

Toward Improved Goals-Of-Care Documentation in Advanced Cancer: Report on the Development of a Quality Improvement Initiative

“…In addition, a targeted approach to identifying patients who qualify for acp discussions has been shown to increase uptake in patients who engage in acp discussions 17 . Studies have shown that various strategies, including identifying patients from health records 18 , providing electronic prompts for physicians 19 , and educating staff and regularly reporting results 17,18 can increase the rate of goc documentation.…”

Documentation of Advance Directives and Code Status in Electronic Medical Records to Honor Goals of Care

“…11 Electronic prompts within EHR systems for AD documentation updates at the time of care encounters have been shown to increase code status documentation within medical records. [12][13][14] A recent systematic review identified automated prompts, documentation prompts, and electronic order sets as the most common EHR tools reported to improve ACP documentation. 15 Communication regarding goals of care is essential and should be enhanced with EHR, not hindered by EHR.…”