Impact of a Care Directives Activity Tab in the Electronic Health Record on Documentation of Advance Care Planning

Turley, Marianne; Meng, Di; Kanter, Michael H.; Garrido, Terhilda

doi:10.7812/tpp/15-103

Cited by 33 publications

(50 citation statements)

References 19 publications

(22 reference statements)

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“…We used the problem list in the EHR as a surrogate measure of ACP discussions and found that most individuals with serious illnesses did not have digitally extractable ACP documents. Rates of ACP documentation in our sample were similar to those that others have found . Systematic reviews indicate that ACP and early discussions about goals of care enhance quality of life, decrease nonbeneficial care, improve family outcomes, and may reduce costs .…”

Section: Discussionsupporting

confidence: 87%

“…15 Systematic reviews indicate that ACP and early discussions about goals of care enhance quality of life, decrease nonbeneficial care, improve family outcomes, and may reduce costs. 15 Although palliative care is still predominately provided in hospice and hospital settings in the United States, [16][17][18] outpatient palliative care is growing. 19 The PAMF community-based interdisciplinary palliative care program has significantly improved ACP practices for individuals at PAMF, although its reach is still limited, with only 6% of seriously ill individuals who had not received palliative care before 2013 receiving palliative care between 2013 and 2014.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Community‐Based Palliative Care and Advance Care Planning Documentation: Evidence from a Multispecialty Group

Tai–Seale

Yan

Dillon

et al. 2017

J American Geriatrics Society

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Only a small percentage of individuals with serious illnesses had ACP documentation in the EHR. Individuals with serious illnesses infrequently used palliative care delivered by board-certified palliative care specialists. Palliative care service use was associated with higher rates of ACP after controlling for organizational and individual characteristics using a propensity score weighting method. Scalable interventions targeted at non-palliative care clinicians for universal access to ACP are needed.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Community‐Based Palliative Care and Advance Care Planning Documentation: Evidence from a Multispecialty Group

Tai–Seale

Yan

Dillon

et al. 2017

J American Geriatrics Society

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“…In fact, the rates of AD completion and EHR accessibility observed in this trial were greater than the corresponding rates observed in clinical settings. [41][42][43] JAMA Network Open | Critical Care Medicine…”

Section: Limitationsmentioning

confidence: 99%

Effect of Default Options in Advance Directives on Hospital-Free Days and Care Choices Among Seriously Ill Patients

et al. 2020

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IMPORTANCE There is limited evidence regarding how patients make choices in advance directives (ADs) or whether these choices influence subsequent care. OBJECTIVE To examine whether default options in ADs influence care choices and clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial included 515 patients who met criteria for having serious illness and agreed to participate. Patients were enrolled at 20

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“…52,53 Advance care planning is documented in diverse ways by different clinicians and can be stored in various locations in the EHR that may include a specific EHR module, a specific note type, or a standard clinic or hospital progress note with no overt flags to signal this content. 52 Widespread use of well-designed, comprehensive, and retrievable templates would facilitate documentation of advance care planning and goals-of-care conversations, and could also provide a guide for these discussions. 54 Natural language processing (NLP) and machine learning also hold promise for facilitating quality metrics related to advance care planning and goals-of-care discussions.…”

Section: Challenges and Lessons Learned From Ehr-based Metricsmentioning

confidence: 99%

Using Electronic Health Records for Quality Measurement and Accountability in Care of the Seriously Ill: Opportunities and Challenges

Curtis

Sathitratanacheewin

Starks

et al. 2018

Journal of Palliative Medicine

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Background: As our population ages and the burden of chronic illness rises, there is increasing need to implement quality metrics that measure and benchmark care of the seriously ill, including the delivery of both primary care and specialty palliative care. Such metrics can be used to drive quality improvement, value-based payment, and accountability for population-based outcomes. Methods: In this article, we examine use of the electronic health record (EHR) as a tool to assess quality of serious illness care through narrative review and description of a palliative care quality metrics program in a large healthcare system. Results: In the search for feasible, reliable, and valid palliative care quality metrics, the EHR is an attractive option for collecting quality data on large numbers of seriously ill patients. However, important challenges to using EHR data for quality improvement and accountability exist, including understanding the validity, reliability, and completeness of the data, as well as acknowledging the difference between care documented and care delivered. Challenges also include developing achievable metrics that are clearly linked to patient and family outcomes and addressing data interoperability across sites as well as EHR platforms and vendors. This article summarizes the strengths and weakness of the EHR as a data source for accountability of communityand population-based programs for serious illness, describes the implementation of EHR data in the palliative care quality metrics program at the University of Washington, and, based on that experience, discusses opportunities and challenges. Our palliative care metrics program was designed to serve as a resource for other healthcare systems. Discussion: Although the EHR offers great promise for enhancing quality of care provided for the seriously ill, significant challenges remain to operationalizing this promise on a national scale and using EHR data for population-based quality and accountability.

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Impact of a Care Directives Activity Tab in the Electronic Health Record on Documentation of Advance Care Planning

Cited by 33 publications

References 19 publications

Community‐Based Palliative Care and Advance Care Planning Documentation: Evidence from a Multispecialty Group

Community‐Based Palliative Care and Advance Care Planning Documentation: Evidence from a Multispecialty Group

Effect of Default Options in Advance Directives on Hospital-Free Days and Care Choices Among Seriously Ill Patients

Using Electronic Health Records for Quality Measurement and Accountability in Care of the Seriously Ill: Opportunities and Challenges

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