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Availability of Advance Care Planning Documentation for Older Emergency Department Patients: A Cross-Sectional Study.
J Palliat Med. 2017 01; 20(1):74-78.JP

Abstract

INTRODUCTION

Increasing advance care planning (ACP) among older adults is a national priority. Documentation of ACP in the electronic health record (EHR) is particularly important during emergency care.

OBJECTIVE

We sought to characterize completion and availability of ACP among a subset of older patients at an academic emergency department (ED) with an integrated EHR.

METHODS

In this cross-sectional study, patients were eligible if aged ≥80 years or aged 65-79 with ≥1 indicator of high risk for short-term mortality. Patient-reported completion of ACP and availability of ACP documentation in the EHR were assessed.

RESULTS

Among study patients (n = 104), 59% reported completing some form of ACP: living will 52%, heathcare power of attorney 54%, do not resuscitate 38%, and medical orders for scope of treatment or physician orders for life-sustaining treatment 6%. Whites were more likely to report having some form of ACP than minorities (66% vs. 37%, p < 0.01), as were patients aged ≥80 years than those aged 65-79 (79% vs. 44%, p < 0.01). Only 13% of all patients had either a current code status or any other current ACP documentation in the EHR. Among patients whose primary care provider uses the same EHR system as the study ED, only 19% had a current code status or any other ACP documentation in the EHR.

CONCLUSION

In a sample of older ED patients likely to benefit from ACP, few patients had documented end-of-life care preferences in the EHR.

Authors+Show Affiliations

1 Department of Emergency Medicine, University of North Carolina , Chapel Hill, North Carolina. 2 Division of Geriatric Medicine, Department of Medicine, University of North Carolina , Chapel Hill, North Carolina.1 Department of Emergency Medicine, University of North Carolina , Chapel Hill, North Carolina.1 Department of Emergency Medicine, University of North Carolina , Chapel Hill, North Carolina.1 Department of Emergency Medicine, University of North Carolina , Chapel Hill, North Carolina.1 Department of Emergency Medicine, University of North Carolina , Chapel Hill, North Carolina.3 Department of Emergency Medicine and School of Nursing, University of North Carolina , Chapel Hill, North Carolina.1 Department of Emergency Medicine, University of North Carolina , Chapel Hill, North Carolina. 2 Division of Geriatric Medicine, Department of Medicine, University of North Carolina , Chapel Hill, North Carolina.2 Division of Geriatric Medicine, Department of Medicine, University of North Carolina , Chapel Hill, North Carolina.4 Department of Medicine, Massachusetts General Hospital , Boston, Massachusetts.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27622294

Citation

Platts-Mills, Timothy F., et al. "Availability of Advance Care Planning Documentation for Older Emergency Department Patients: a Cross-Sectional Study." Journal of Palliative Medicine, vol. 20, no. 1, 2017, pp. 74-78.
Platts-Mills TF, Richmond NL, LeFebvre EM, et al. Availability of Advance Care Planning Documentation for Older Emergency Department Patients: A Cross-Sectional Study. J Palliat Med. 2017;20(1):74-78.
Platts-Mills, T. F., Richmond, N. L., LeFebvre, E. M., Mangipudi, S. A., Hollowell, A. G., Travers, D., Biese, K., Hanson, L. C., & Volandes, A. E. (2017). Availability of Advance Care Planning Documentation for Older Emergency Department Patients: A Cross-Sectional Study. Journal of Palliative Medicine, 20(1), 74-78.
Platts-Mills TF, et al. Availability of Advance Care Planning Documentation for Older Emergency Department Patients: a Cross-Sectional Study. J Palliat Med. 2017;20(1):74-78. PubMed PMID: 27622294.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Availability of Advance Care Planning Documentation for Older Emergency Department Patients: A Cross-Sectional Study. AU - Platts-Mills,Timothy F, AU - Richmond,Natalie L, AU - LeFebvre,Eric M, AU - Mangipudi,Sowmya A, AU - Hollowell,Allison G, AU - Travers,Debbie, AU - Biese,Kevin, AU - Hanson,Laura C, AU - Volandes,Angelo E, Y1 - 2016/09/13/ PY - 2016/9/14/pubmed PY - 2018/3/6/medline PY - 2016/9/14/entrez SP - 74 EP - 78 JF - Journal of palliative medicine JO - J Palliat Med VL - 20 IS - 1 N2 - INTRODUCTION: Increasing advance care planning (ACP) among older adults is a national priority. Documentation of ACP in the electronic health record (EHR) is particularly important during emergency care. OBJECTIVE: We sought to characterize completion and availability of ACP among a subset of older patients at an academic emergency department (ED) with an integrated EHR. METHODS: In this cross-sectional study, patients were eligible if aged ≥80 years or aged 65-79 with ≥1 indicator of high risk for short-term mortality. Patient-reported completion of ACP and availability of ACP documentation in the EHR were assessed. RESULTS: Among study patients (n = 104), 59% reported completing some form of ACP: living will 52%, heathcare power of attorney 54%, do not resuscitate 38%, and medical orders for scope of treatment or physician orders for life-sustaining treatment 6%. Whites were more likely to report having some form of ACP than minorities (66% vs. 37%, p < 0.01), as were patients aged ≥80 years than those aged 65-79 (79% vs. 44%, p < 0.01). Only 13% of all patients had either a current code status or any other current ACP documentation in the EHR. Among patients whose primary care provider uses the same EHR system as the study ED, only 19% had a current code status or any other ACP documentation in the EHR. CONCLUSION: In a sample of older ED patients likely to benefit from ACP, few patients had documented end-of-life care preferences in the EHR. SN - 1557-7740 UR - https://www.unboundmedicine.com/medline/citation/27622294/Availability_of_Advance_Care_Planning_Documentation_for_Older_Emergency_Department_Patients:_A_Cross_Sectional_Study_ L2 - https://www.liebertpub.com/doi/10.1089/jpm.2016.0243?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -