Promoting Advance Care Planning Documentation for Veterans Through an Innovative Electronic Medical Record Template

Nakagawa, Shunichi; Clark, Elizabeth; Cobbs, Elizabeth; Livote, Elayne; Awan, Kanwal S.; Blackstone, Karen; Lindenberger, Elizabeth

doi:10.1111/jgs.13008

Cited by 5 publications

(9 citation statements)

References 6 publications

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“…It cannot be assumed that a tool for eliciting patient preferences and priorities has only positive or neutral effects. This is hinted at in a study by Nakagowa al 31 on advanced care planning, where 1 in 20 participants indicated that they were unwilling to discuss preferences for care, perhaps suggesting seeking that this kind of information has the potential for making patients feel uncomfortable.…”

Section: Discussionmentioning

confidence: 99%

Making patient values visible in healthcare: a systematic review of tools to assess patient treatment priorities and preferences in the context of multimorbidity

et al. 2016

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ObjectivesTo identify studies of existing instruments available for clinicians to record overall patient preferences and priorities for care, suitable for use in routine primary care practice in patients with multimorbidity. To examine the data for all identified tools with respect to validity, acceptability and effect on health outcomes.DesignSystematic Review.Data sourcesMEDLINE, EMBASE and Cochrane databases, each with a predefined search strategy.Eligibility criteriaCitations were included if they reported a tool used to record patient priorities or preferences for treatment, and quantitative or qualitative results following administration of the tool.ResultsOur search identified 189 potential studies of which 6 original studies and 2 discussion papers were included after screening for relevance. 5 of 6 studies (83%) were of cross-sectional design and of moderate quality. All studies reported on the usability of a tool in order to elicit patient preferences. No studies reported on changes to patient-specific healthcare outcomes as a consequence of recording preferences and priorities. 1 of 6 studies reported on eliciting patient preference in the context of multimorbidity. No studies incorporated patient preferences into an electronic medical record.ConclusionsGiven the importance of eliciting patient priorities and preferences in providing patient-centred care in the context of multimorbidity and polypharmacy, we found surprisingly few relevant tools. Some aspects of the tools used for single-disease contexts may also be useful in the context of multimorbidity. There is an urgent need to develop ways to make patient priorities explicitly visible in the clinical record and medical decision-making and to test the effect on patient-relevant outcomes.

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Section: Discussionmentioning

confidence: 99%

Making patient values visible in healthcare: a systematic review of tools to assess patient treatment priorities and preferences in the context of multimorbidity

et al. 2016

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“…15 Study populations, interventions, and outcomes were heterogeneous (Table 1). Eight studies occurred exclusively in the outpatient setting, [16][17][18][19][20][21][22][23] 5 occurred exclusively in the inpatient setting, [24][25][26][27][28] and 3 occurred in both inpatient and outpatient settings. 15,29,30 Four studies examined oncology patients exclusively, [19][20][21][22] 1 study examined heart failure patients exclusively, 29 and the remaining studies included multiple diagnoses and patient groups.…”

Section: Resultsmentioning

confidence: 99%

“…24 Automated prompts. Seven studies reported using the EHR to prompt ACP discussions, [16][17][18]20,23,26,28 and 1 reported an e-mail prompt in association with an EHR documentation template. 22 The triggers for electronic prompts included patient criteria, such as age 16,17,23 or diagnoses associated with limited life expectancy.…”

Section: Resultsmentioning

confidence: 99%

“…20,22 The remaining studies reported only descriptive analysis after implementation of the intervention. 15,19,21,[25][26][27]30 Of the studies providing data regarding efficacy, 5 studies specifically evaluated the efficacy of an EHR intervention: 2 examined prompts, 16,17 1 examined an order set, 28 1 examined a documentation template, 15 and 1 examined multiple EHR components. 18 Six studies provided data on the efficacy of multicomponent interventions, including an EHR component.…”

Section: Efficacy Of Interventionsmentioning

confidence: 99%

“…16,17,20,23,24,29 All studies reporting data on efficacy demonstrated an improvement in 1 or more ACP outcomes. The most commonly reported outcomes included documentation of an ACP conversation in the EHR, [16][17][18]20,26,28,30 the placement of code status orders, 19,21,22,25,[27][28][29] and completion of an advance directive form. 16,24,23…”

Section: Efficacy Of Interventionsmentioning

confidence: 99%

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Utilizing the Electronic Health Record to Improve Advance Care Planning: A Systematic Review

Huber

Highland

Krishnamoorthi

et al. 2017

Am J Hosp Palliat Care

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Across race, ethnicity, and language: An intervention to improve advance care planning documentation unmasks health disparities

Dutta,

Flynn,

Oreper

et al. 2023

Journal of Hospital Medicine

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BackgroundRacial and ethnic minority groups are less likely to have advance directives and living wills, despite the importance of advanced care planning (ACP) in end‐of‐life care. We aimed to understand the impact of an intervention to improve ACP documentation across race, ethnicity, and language on hospitalized patients at our institution.MethodsWe launched an intervention to improve the rates of ACP documentation for hospitalized patients aged >75 or with advanced illness defined by the International Classification of Diseases 10th Revision codes. We analyzed ACP completion rates, preintervention, and intervention, and used interrupted time‐series analyses to measure the differential impact of the intervention across race, ethnicity, and language.Key ResultsA total of 10,220 patients met the inclusion criteria. Overall rates of ACP documentation improved from 13.9% to 43.7% in the intervention period, with a 2.47% monthly increase in ACP documentation compared to baseline (p < .001). During the intervention period, the rate of ACP documentation increased by 2.72% per month for non‐Hispanic White patients (p < .001), by 1.84% per month for Latinx patients (p < .001), and by 1.9% per month for Black patients (p < .001). Differences in the intervention trends between non‐Hispanic White and Latinx patients (p = .04) and Black patients (p = .04) were significant.ConclusionsAn intervention designed to improve ACP documentation in hospitalized patients widened a disparity across race and ethnicity with Latinx and Black patients having lower rates of improvement. Our findings reinforce the need to measure the impact of quality improvement interventions on existing health disparities and to implement specific strategies to prevent worsening disparities.

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Promoting Advance Care Planning Documentation for Veterans Through an Innovative Electronic Medical Record Template

Cited by 5 publications

References 6 publications

Making patient values visible in healthcare: a systematic review of tools to assess patient treatment priorities and preferences in the context of multimorbidity

Making patient values visible in healthcare: a systematic review of tools to assess patient treatment priorities and preferences in the context of multimorbidity

Utilizing the Electronic Health Record to Improve Advance Care Planning: A Systematic Review

Across race, ethnicity, and language: An intervention to improve advance care planning documentation unmasks health disparities

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