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Advance Care Planning in a Geriatric Primary Care Clinic: A Retrospective Chart Review.
Am J Hosp Palliat Care. 2019 Jan; 36(1):24-27.AJ

Abstract

PURPOSE:

Advance care planning (ACP) is theorized to benefit both the patient and their family when end of life is near as well as earlier in the course of serious illness. However, ACP remains underutilized, and little is known about the nature of ACP documentation in geriatrics practices. The study investigated the prevalence and nature of ACP documentation within a geriatric primary care clinic.

METHODS:

A retrospective chart review was conducted on a randomly selected sample of electronic medical record (EMR) charts. The sample consisted of patients aged 65 and older who were seen in the clinic from January 1, 2015, to December 31, 2016. Charts were reviewed for ACP documentation and data regarding age, gender, race, religion, comorbidities (end-stage renal disease, congestive heart failure, cancer, and dementia), recent hospitalizations, and visit type.

RESULTS:

Ninety-eight charts were reviewed (n = 98). Nine patients (9.18%) had an advance directive (AD) or power of attorney (POA) available within their EMR. Twenty-five patients (25.5%) had provider notes documenting that they have an AD, POA, or preferred health-care decision maker; however, no documents were available. The remaining 64 (65.3%) patients had no evidence of ACP documentation within their EMR. Age was the only demographic variable associated with completion of an AD (P = .038).

DISCUSSION:

The rate of ACP documentation (34.6%) was lower than the average among US adults aged 65 and over (45.6%); further, most patients with ACP documentation did not have an AD or POA on file. The authors plan to reevaluate ACP statistics in the same office following a future intervention.

Authors+Show Affiliations

1 Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.2 Department of Family and Community Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.2 Department of Family and Community Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.2 Department of Family and Community Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.2 Department of Family and Community Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.2 Department of Family and Community Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30071753

Citation

Barkley, Ariana, et al. "Advance Care Planning in a Geriatric Primary Care Clinic: a Retrospective Chart Review." The American Journal of Hospice & Palliative Care, vol. 36, no. 1, 2019, pp. 24-27.
Barkley A, Liquori M, Cunningham A, et al. Advance Care Planning in a Geriatric Primary Care Clinic: A Retrospective Chart Review. Am J Hosp Palliat Care. 2019;36(1):24-27.
Barkley, A., Liquori, M., Cunningham, A., Liantonio, J., Worster, B., & Parks, S. (2019). Advance Care Planning in a Geriatric Primary Care Clinic: A Retrospective Chart Review. The American Journal of Hospice & Palliative Care, 36(1), 24-27. https://doi.org/10.1177/1049909118791126
Barkley A, et al. Advance Care Planning in a Geriatric Primary Care Clinic: a Retrospective Chart Review. Am J Hosp Palliat Care. 2019;36(1):24-27. PubMed PMID: 30071753.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Advance Care Planning in a Geriatric Primary Care Clinic: A Retrospective Chart Review. AU - Barkley,Ariana, AU - Liquori,Mike, AU - Cunningham,Amy, AU - Liantonio,John, AU - Worster,Brooke, AU - Parks,Susan, Y1 - 2018/08/02/ PY - 2018/8/4/pubmed PY - 2019/6/14/medline PY - 2018/8/4/entrez KW - advance care planning KW - advance directive KW - electronic medical record KW - geriatrics KW - power of attorney KW - primary care SP - 24 EP - 27 JF - The American journal of hospice & palliative care JO - Am J Hosp Palliat Care VL - 36 IS - 1 N2 - PURPOSE:: Advance care planning (ACP) is theorized to benefit both the patient and their family when end of life is near as well as earlier in the course of serious illness. However, ACP remains underutilized, and little is known about the nature of ACP documentation in geriatrics practices. The study investigated the prevalence and nature of ACP documentation within a geriatric primary care clinic. METHODS:: A retrospective chart review was conducted on a randomly selected sample of electronic medical record (EMR) charts. The sample consisted of patients aged 65 and older who were seen in the clinic from January 1, 2015, to December 31, 2016. Charts were reviewed for ACP documentation and data regarding age, gender, race, religion, comorbidities (end-stage renal disease, congestive heart failure, cancer, and dementia), recent hospitalizations, and visit type. RESULTS:: Ninety-eight charts were reviewed (n = 98). Nine patients (9.18%) had an advance directive (AD) or power of attorney (POA) available within their EMR. Twenty-five patients (25.5%) had provider notes documenting that they have an AD, POA, or preferred health-care decision maker; however, no documents were available. The remaining 64 (65.3%) patients had no evidence of ACP documentation within their EMR. Age was the only demographic variable associated with completion of an AD (P = .038). DISCUSSION:: The rate of ACP documentation (34.6%) was lower than the average among US adults aged 65 and over (45.6%); further, most patients with ACP documentation did not have an AD or POA on file. The authors plan to reevaluate ACP statistics in the same office following a future intervention. SN - 1938-2715 UR - https://www.unboundmedicine.com/medline/citation/30071753/Advance_Care_Planning_in_a_Geriatric_Primary_Care_Clinic:_A_Retrospective_Chart_Review_ L2 - https://journals.sagepub.com/doi/10.1177/1049909118791126?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -