scholarly journals Validation of a Novel Electronic Health Record Patient Portal Advance Care Planning Delivery System

2018 ◽  
Vol 20 (6) ◽  
pp. e208 ◽  
Author(s):  
Seuli Bose-Brill ◽  
Michelle Feeney ◽  
Laura Prater ◽  
Laura Miles ◽  
Angela Corbett ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Delivery System ◽  
Advance Care Planning ◽  
Health Record ◽  
Patient Portal ◽  
Care Planning ◽  
Advance Care ◽  
Electronic Health

scholarly journals Validation of a Novel Electronic Health Record Patient Portal Advance Care Planning Delivery System (Preprint)

2017 ◽  
Author(s):  
Seuli Bose-Brill ◽  
Michelle Feeney ◽  
Laura Prater ◽  
Laura Miles ◽  
Angela Corbett ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Advance Care Planning ◽  
Standard Care ◽  
Health Record ◽  
Patient Portal ◽  
Care Planning ◽  
Intervention Site ◽  
Advance Care ◽  
Electronic Health

BACKGROUND Advance care planning allows patients to articulate their future care preferences should they no longer be able to make decisions on their own. Early advance care planning in outpatient settings provides benefits such as less aggressive care and fewer hospitalizations, yet it is underutilized due to barriers such as provider time constraints and communication complexity. Novel methods, such as patient portals, provide a unique opportunity to conduct advance care planning previsit planning for outpatient care. This follow-up to our pilot study aimed to conduct pragmatic testing of a novel electronic health record-tethered framework and its effects on advance care planning delivery in a real-world primary care setting. OBJECTIVE Our intervention tested a previsit advance care planning workflow centered around a framework sent via secure electronic health record-linked patient portal in a real-world clinical setting. The primary objective of this study was to determine its impact on frequency and quality of advance care planning documentation. METHODS We conducted a pragmatic trial including 2 sister clinical sites, one site implementing the intervention and the other continuing standard care. A total of 419 patients aged between 50 and 93 years with active portal accounts received intervention (n=200) or standard care (n=219). Chart review analyzed the presence of advance care planning and its quality and was graded with previously established scoring criteria based on advance care planning best practice guidelines from multiple nations. RESULTS A total of 19.5% (39/200) of patients who received previsit planning responded to the framework. We found that the intervention site had statistically significant improvement in new advance care planning documentation rates (P<.01) and quality (P<.01) among all eligible patients. Advance care planning documentation rates increased by 105% (19/39 to 39/39) and quality improved among all patients who engaged in the previsit planning framework (n=39). Among eligible patients aged between 50 and 60 years at the intervention site, advance care planning documentation rates increased by 37% (27/96 to 37/96). Advance care planning documentation rates increased 34% among high users (27/67 to 36/67). CONCLUSIONS Advance care planning previsit planning using a secure electronic health record-supported patient portal framework yielded improvement in the presence of advance care planning documentation, with highest improvement in active patient portal users and patients aged between 50 and 60 years. Targeted previsit patient portal advance care planning delivery in these populations can potentially improve the quality of care in these populations.

Considerations for Integrating Advance Care Planning Into the Electronic Health Record: A Primer for Clinicians

2020 ◽  
Vol 37 (12) ◽  
pp. 1004-1008
Author(s):  
Adam Moses ◽  
Ajay Dharod ◽  
Jeff Williamson ◽  
Nicholas M. Pajewski ◽  
Daniel Tuerff ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Electronic Health Record ◽  
Advance Care Planning ◽  
Health Record ◽  
Care Planning ◽  
Basic Understanding ◽  
Advance Care ◽  
Electronic Health ◽  
Outpatient Settings

Opportunities for expanding advance care planning (ACP) throughout the health-care system make it critical that primary care (PC) providers have a basic understanding of how the electronic health record (EHR) can aid promoting ACP discussions and documentation. This article will offer PC providers 5 useful tips for implementing ACP in outpatient settings utilizing the EHR.

A Yet Unrealized Promise: Structured Advance Care Planning Elements in the Electronic Health Record

2021 ◽  
Author(s):  
Joshua R. Lakin ◽  
Daniel A. Gundersen ◽  
Charlotta Lindvall ◽  
Michael K. Paasche-Orlow ◽  
James A. Tulsky ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Advance Care Planning ◽  
Health Record ◽  
Care Planning ◽  
Advance Care ◽  
Electronic Health

Locating Advance Care Planning Documents in the Electronic Health Record during Emergency Care

2021 ◽  
Author(s):  
Olivia Pyles ◽  
Christopher M. Hritz ◽  
Peg Gulker ◽  
Jansi D. Straveler ◽  
Corita R. Grudzen ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Advance Care Planning ◽  
Emergency Care ◽  
Health Record ◽  
Care Planning ◽  
Advance Care ◽  
Electronic Health

scholarly journals Implementation of Advance Care Planning in Oncology: A Review of the Literature

2017 ◽  
Vol 13 (10) ◽  
pp. 657-662 ◽  
Author(s):  
Christine M. Bestvina ◽  
Blase N. Polite
Keyword(s):  
Health Care ◽  
Cardiopulmonary Resuscitation ◽  
Electronic Health Record ◽  
Advance Care Planning ◽  
Decision Aids ◽  
Comfort Level ◽  
Health Record ◽  
Care Planning ◽  
Advance Care ◽  
Electronic Health

Advance care planning (ACP) should be initiated early and be readdressed often for patients with cancer. This directive is expressed in the Institute of Medicine’s report, “Dying in America,” and is a component of several quality metrics, including ASCO’s Quality Oncology Practice Initiative and the Centers for Medicare & Medicaid Services Oncology Care Model. Although simple in concept, implementation in practice is challenging. A variety of patient education tools exist in several different forms, including pamphlets, guidebooks, and question prompt lists, with the strongest data supporting the use of video decision aids that depict cardiopulmonary resuscitation. These educational tools should address topics that include anticancer treatment, cardiopulmonary resuscitation, and health care surrogates. Physician prompts in the electronic health record to discuss ACP should be considered. Health care provider training should be offered to meet the needs and comfort level of the practitioners who conduct the intervention. Intervention studies that assessed ACP documentation rates as the primary end point increased documentation from 15% to 30% to 40%. Additional well-conducted randomized studies are needed to understand the intervention characteristics that can further improve the completion and documentation of ACP. Further research is needed to determine if there is a difference in outcome based on which provider conducts ACP as well as how to maximize the benefits of the electronic health record, such as prompts to readdress ACP.

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