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Use of an Ambulatory Patient Portal for Advance Care Planning Engagement.
J Am Board Fam Med. 2019 Nov-Dec; 32(6):925-930.JA

Abstract

BACKGROUND

Primary care clinics need sustainable, population-based approaches to engage patients in advance care planning (ACP). Patient portal-based ACP tools may provide an option for patient engagement.

OBJECTIVE

To increase ACP outcomes by engaging older adults through portal-based ACP tools, including an electronic Medical Durable Power of Attorney (MDPOA) form.

METHODS

Geriatric clinic pilot of a multi-modal population-based outreach strategy for portal-based ACP tools. Outreach was to patients (n = 105) who were 65 years and older with an active portal account, no cognitive impairment, and no MDPOA on file. Patients received a motivational message via the portal and, if not read within 2 weeks, a mailed postcard about the portal-based ACP tools. Primary outcome was composite of any ACP action at 1-year including 1) new advance directive (AD) in the electronic health record, 2) use of portal-based ACP tools, or 3) documented ACP discussion with a provider.

RESULTS

Sixty-five older adults read the electronic message at 12 months. Seventeen (16%) engaged in at least 1 ACP action. Fourteen of 17 engaged by adding an AD to their record. More patients completed an AD on article or brought a previously completed AD to clinic, compared with choosing to complete an electronic MDPOA via the portal.

CONCLUSIONS

Brief motivational messages about ACP via a patient portal is feasible and may increase ACP outcomes for older adults in primary care. Future studies should evaluate population-based portal outreach strategies in combination with team-based workflows to enhance patient engagement in ACP.

Authors+Show Affiliations

From the Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO (AB, AED, BP, HDL); VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO (HDL).From the Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO (AB, AED, BP, HDL); VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO (HDL).From the Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO (AB, AED, BP, HDL); VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO (HDL).From the Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO (AB, AED, BP, HDL); VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO (HDL). Hillary.Lum@ucdenver.edu.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

31704762

Citation

Brungardt, Adreanne, et al. "Use of an Ambulatory Patient Portal for Advance Care Planning Engagement." Journal of the American Board of Family Medicine : JABFM, vol. 32, no. 6, 2019, pp. 925-930.
Brungardt A, Daddato AE, Parnes B, et al. Use of an Ambulatory Patient Portal for Advance Care Planning Engagement. Journal of the American Board of Family Medicine : JABFM. 2019;32(6):925-930.
Brungardt, A., Daddato, A. E., Parnes, B., & Lum, H. D. (2019). Use of an Ambulatory Patient Portal for Advance Care Planning Engagement. Journal of the American Board of Family Medicine : JABFM, 32(6), 925-930. https://doi.org/10.3122/jabfm.2019.06.190016
Brungardt A, et al. Use of an Ambulatory Patient Portal for Advance Care Planning Engagement. Journal of the American Board of Family Medicine : JABFM. 2019 Nov-Dec;32(6):925-930. PubMed PMID: 31704762.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of an Ambulatory Patient Portal for Advance Care Planning Engagement. AU - Brungardt,Adreanne, AU - Daddato,Andrea E, AU - Parnes,Bennett, AU - Lum,Hillary D, PY - 2019/01/16/received PY - 2019/06/06/revised PY - 2019/06/21/accepted PY - 2019/11/10/entrez PY - 2019/11/11/pubmed PY - 2020/9/15/medline KW - Advance Care Planning KW - Advance Directives KW - Doctor Patient Relations KW - Electronic Health Records KW - End of Life Care KW - Internet KW - Patient Participation KW - Primary Health Care KW - Quality Improvement KW - Workflow SP - 925 EP - 930 JF - Journal of the American Board of Family Medicine : JABFM VL - 32 IS - 6 N2 - BACKGROUND: Primary care clinics need sustainable, population-based approaches to engage patients in advance care planning (ACP). Patient portal-based ACP tools may provide an option for patient engagement. OBJECTIVE: To increase ACP outcomes by engaging older adults through portal-based ACP tools, including an electronic Medical Durable Power of Attorney (MDPOA) form. METHODS: Geriatric clinic pilot of a multi-modal population-based outreach strategy for portal-based ACP tools. Outreach was to patients (n = 105) who were 65 years and older with an active portal account, no cognitive impairment, and no MDPOA on file. Patients received a motivational message via the portal and, if not read within 2 weeks, a mailed postcard about the portal-based ACP tools. Primary outcome was composite of any ACP action at 1-year including 1) new advance directive (AD) in the electronic health record, 2) use of portal-based ACP tools, or 3) documented ACP discussion with a provider. RESULTS: Sixty-five older adults read the electronic message at 12 months. Seventeen (16%) engaged in at least 1 ACP action. Fourteen of 17 engaged by adding an AD to their record. More patients completed an AD on article or brought a previously completed AD to clinic, compared with choosing to complete an electronic MDPOA via the portal. CONCLUSIONS: Brief motivational messages about ACP via a patient portal is feasible and may increase ACP outcomes for older adults in primary care. Future studies should evaluate population-based portal outreach strategies in combination with team-based workflows to enhance patient engagement in ACP. SN - 1558-7118 UR - https://www.unboundmedicine.com/medline/citation/31704762/Use_of_an_Ambulatory_Patient_Portal_for_Advance_Care_Planning_Engagement_ DB - PRIME DP - Unbound Medicine ER -