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Provider Perspectives on Advance Care Planning Documentation in the Electronic Health Record: The Experience of Primary Care Providers and Specialists Using Advance Health-Care Directives and Physician Orders for Life-Sustaining Treatment.
Am J Hosp Palliat Care. 2017 Dec; 34(10):918-924.AJ

Abstract

CONTEXT

Advance care planning (ACP) is valued by patients and clinicians, yet documenting ACP in an accessible manner is problematic.

OBJECTIVES

In order to understand how providers incorporate electronic health record (EHR) ACP documentation into clinical practice, we interviewed providers in primary care and specialty departments about ACP practices (n = 13) and analyzed EHR data on 358 primary care providers (PCPs) and 79 specialists at a large multispecialty group practice.

METHODS

Structured interviews were conducted with 13 providers with high and low rates of ACP documentation in primary care, oncology, pulmonology, and cardiology departments. The EHR problem list data on Advance Health Care Directives (AHCDs) and Physician Orders for Life-Sustaining Treatment (POLST) were used to calculate ACP documentation rates.

RESULTS

Examining seriously ill patients ≥65 years with no preexisting ACP documentation seen by providers during 2013 to 2014, 88.6% (AHCD) and 91.1% (POLST) of 79 specialists had zero ACP documentations. Of 358 PCPs, 29.1% (AHCD) and 62.3% (POLST) had zero ACP documentations. Interviewed PCPs often believed ACP documentation was beneficial and accessible, while specialists more often did not. Specialists expressed more confusion about documenting ACP, whereas PCPs reported standard clinic workflows. Problems with interoperability between outpatient and inpatient EHR systems and lack of consensus about who should document ACP were sources of variations in practices.

CONCLUSION

Results suggest that providers desire standardized workflows for ACP discussion and documentation. New Medicare reimbursement for ACP and an increasing number of quality metrics for ACP are incentives for health-care systems to address barriers to ACP documentation.

Links

Publisher Full Text
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Authors+Show Affiliations

Dillon E
1 Palo Alto Medical Foundation Research Institute, Mountain View, CA, USA.
Chuang J
1 Palo Alto Medical Foundation Research Institute, Mountain View, CA, USA.
Gupta A
2 Department of Economics, Stanford University, Stanford, CA, USA.
Tapper S
3 Palo Alto Medical Foundation, Department of Palliative Care, Santa Cruz, CA, USA.
Lai S
4 Palo Alto Medical Foundation, Department of Palliative Care, Palo Alto, CA, USA.
Yu P
5 Hartford Health Care Cancer Institute, Memorial Sloan Kettering Cancer Alliance, Hartford, CT, USA.
Ritchie C
6 Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA.
Tai-Seale M
1 Palo Alto Medical Foundation Research Institute, Mountain View, CA, USA.

MeSH

Advance Care PlanningAdvance DirectivesAttitude of Health PersonnelCritical IllnessDocumentationElectronic Health RecordsFemaleHumansLife Support CareMalePrimary Health CareSpecialization

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28196448

Citation

Dillon, Ellis, et al. "Provider Perspectives On Advance Care Planning Documentation in the Electronic Health Record: the Experience of Primary Care Providers and Specialists Using Advance Health-Care Directives and Physician Orders for Life-Sustaining Treatment." The American Journal of Hospice & Palliative Care, vol. 34, no. 10, 2017, pp. 918-924.
Dillon E, Chuang J, Gupta A, et al. Provider Perspectives on Advance Care Planning Documentation in the Electronic Health Record: The Experience of Primary Care Providers and Specialists Using Advance Health-Care Directives and Physician Orders for Life-Sustaining Treatment. Am J Hosp Palliat Care. 2017;34(10):918-924.
Dillon, E., Chuang, J., Gupta, A., Tapper, S., Lai, S., Yu, P., Ritchie, C., & Tai-Seale, M. (2017). Provider Perspectives on Advance Care Planning Documentation in the Electronic Health Record: The Experience of Primary Care Providers and Specialists Using Advance Health-Care Directives and Physician Orders for Life-Sustaining Treatment. The American Journal of Hospice & Palliative Care, 34(10), 918-924. https://doi.org/10.1177/1049909117693578
Dillon E, et al. Provider Perspectives On Advance Care Planning Documentation in the Electronic Health Record: the Experience of Primary Care Providers and Specialists Using Advance Health-Care Directives and Physician Orders for Life-Sustaining Treatment. Am J Hosp Palliat Care. 2017;34(10):918-924. PubMed PMID: 28196448.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Provider Perspectives on Advance Care Planning Documentation in the Electronic Health Record: The Experience of Primary Care Providers and Specialists Using Advance Health-Care Directives and Physician Orders for Life-Sustaining Treatment. AU - Dillon,Ellis, AU - Chuang,Judith, AU - Gupta,Atul, AU - Tapper,Sharon, AU - Lai,Steve, AU - Yu,Peter, AU - Ritchie,Christine, AU - Tai-Seale,Ming, Y1 - 2017/02/15/ PY - 2017/2/16/pubmed PY - 2018/6/27/medline PY - 2017/2/16/entrez KW - Advance Health Care Directive (AHCD) KW - Physician Orders for Life-Sustaining Treatment (POLST) KW - advance care planning KW - documentation KW - electronic health record KW - qualitative SP - 918 EP - 924 JF - The American journal of hospice & palliative care JO - Am J Hosp Palliat Care VL - 34 IS - 10 N2 - CONTEXT: Advance care planning (ACP) is valued by patients and clinicians, yet documenting ACP in an accessible manner is problematic. OBJECTIVES: In order to understand how providers incorporate electronic health record (EHR) ACP documentation into clinical practice, we interviewed providers in primary care and specialty departments about ACP practices (n = 13) and analyzed EHR data on 358 primary care providers (PCPs) and 79 specialists at a large multispecialty group practice. METHODS: Structured interviews were conducted with 13 providers with high and low rates of ACP documentation in primary care, oncology, pulmonology, and cardiology departments. The EHR problem list data on Advance Health Care Directives (AHCDs) and Physician Orders for Life-Sustaining Treatment (POLST) were used to calculate ACP documentation rates. RESULTS: Examining seriously ill patients ≥65 years with no preexisting ACP documentation seen by providers during 2013 to 2014, 88.6% (AHCD) and 91.1% (POLST) of 79 specialists had zero ACP documentations. Of 358 PCPs, 29.1% (AHCD) and 62.3% (POLST) had zero ACP documentations. Interviewed PCPs often believed ACP documentation was beneficial and accessible, while specialists more often did not. Specialists expressed more confusion about documenting ACP, whereas PCPs reported standard clinic workflows. Problems with interoperability between outpatient and inpatient EHR systems and lack of consensus about who should document ACP were sources of variations in practices. CONCLUSION: Results suggest that providers desire standardized workflows for ACP discussion and documentation. New Medicare reimbursement for ACP and an increasing number of quality metrics for ACP are incentives for health-care systems to address barriers to ACP documentation. SN - 1938-2715 UR - https://www.unboundmedicine.com/medline/citation/28196448/Provider_Perspectives_on_Advance_Care_Planning_Documentation_in_the_Electronic_Health_Record:_The_Experience_of_Primary_Care_Providers_and_Specialists_Using_Advance_Health_Care_Directives_and_Physician_Orders_for_Life_Sustaining_Treatment_ L2 - http://journals.sagepub.com/doi/full/10.1177/1049909117693578?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -