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Validation of a Novel Electronic Health Record Patient Portal Advance Care Planning Delivery System.
J Med Internet Res. 2018 06 26; 20(6):e208.JM

Abstract

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.

Authors+Show Affiliations

Division of General Internal Medicine, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States.Medical Student Research Program, College of Medicine, The Ohio State University, Columbus, OH, United States.College of Public Health, The Ohio State University, Columbus, OH, United States.Division of General Internal Medicine, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States.Division of General Internal Medicine, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States.Division of General Internal Medicine, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29945860

Citation

Bose-Brill, Seuli, et al. "Validation of a Novel Electronic Health Record Patient Portal Advance Care Planning Delivery System." Journal of Medical Internet Research, vol. 20, no. 6, 2018, pp. e208.
Bose-Brill S, Feeney M, Prater L, et al. Validation of a Novel Electronic Health Record Patient Portal Advance Care Planning Delivery System. J Med Internet Res. 2018;20(6):e208.
Bose-Brill, S., Feeney, M., Prater, L., Miles, L., Corbett, A., & Koesters, S. (2018). Validation of a Novel Electronic Health Record Patient Portal Advance Care Planning Delivery System. Journal of Medical Internet Research, 20(6), e208. https://doi.org/10.2196/jmir.9203
Bose-Brill S, et al. Validation of a Novel Electronic Health Record Patient Portal Advance Care Planning Delivery System. J Med Internet Res. 2018 06 26;20(6):e208. PubMed PMID: 29945860.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Validation of a Novel Electronic Health Record Patient Portal Advance Care Planning Delivery System. AU - Bose-Brill,Seuli, AU - Feeney,Michelle, AU - Prater,Laura, AU - Miles,Laura, AU - Corbett,Angela, AU - Koesters,Stephen, Y1 - 2018/06/26/ PY - 2017/10/17/received PY - 2018/03/14/accepted PY - 2018/02/27/revised PY - 2018/6/28/entrez PY - 2018/6/28/pubmed PY - 2019/7/11/medline KW - advance care planning KW - electronic health records KW - patient portal SP - e208 EP - e208 JF - Journal of medical Internet research JO - J. Med. Internet Res. VL - 20 IS - 6 N2 - 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. SN - 1438-8871 UR - https://www.unboundmedicine.com/medline/citation/29945860/Validation_of_a_Novel_Electronic_Health_Record_Patient_Portal_Advance_Care_Planning_Delivery_System_ L2 - https://www.jmir.org/2018/6/e208/ DB - PRIME DP - Unbound Medicine ER -