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Advance Care Planning Among Users of a Patient Portal During the COVID-19 Pandemic: Retrospective Observational Study.
J Med Internet Res. 2020 08 11; 22(8):e21385.JM

Abstract

BACKGROUND

Advance care planning is the process of discussing health care treatment preferences based on patients' personal values, and it often involves the completion of advance directives. In the first months of 2020, a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), began circulating widely in the American state of Colorado, leading to widespread diagnosis of coronavirus disease (COVID-19), hospitalizations, and deaths. In this context, the importance of technology-based, non-face-to-face methods to conduct advance care planning via patient portals has increased.

OBJECTIVE

The aim of this study was to determine the rates of use of a web-based advance care planning tool through a health system-based electronic patient portal both before and in the early months of the COVID-19 pandemic.

METHODS

In 2017, we implemented web-based tools through the patient portal of UCHealth's electronic health record (EHR) for patients to learn about advance care planning and complete an electronically signed medical durable power of attorney (MDPOA) to legally appoint a medical decision maker. Patients accessing the portal can complete and submit a legally valid MDPOA, which becomes part of their medical record. We collected data on the patients' date of MDPOA completion, use of advance care planning messaging, age, sex, and geographic location during the early phase of the COVID-19 pandemic (December 29, 2019, to May 30, 2020).

RESULTS

Over a 5-month period that includes the early phase of the COVID-19 pandemic in Colorado, total monthly use of the advance care planning portal tool increased from 418 users in January to 1037 users in April and then decreased slightly to 815 users in May. The number of MDPOA forms submitted per week increased 2.4-fold after the stay-at-home order was issued in Colorado on March 26, 2020 (P<.001). The mean age of the advance care planning portal users was 47.7 years (SD 16.1), and 2206/3292 (67.0%) were female. Women were more likely than men to complete an MDPOA, particularly in younger age groups (P<.001). The primary use of the advance care planning portal tools was the completion of an MDPOA (3138/3292, 95.3%), compared to sending an electronic message (148/3292, 4.5%). Over 50% of patients who completed an MDPOA did not have a prior agent in the EHR.

CONCLUSIONS

Use of a web-based patient portal to complete an MDPOA increased substantially during the first months of the COVID-19 pandemic in Colorado. There was an increase in advance care planning that corresponded with state government shelter-in-place orders as well as public health reports of increased numbers of COVID-19 cases and deaths. Patient portals are an important tool for providing advance care planning resources and documenting medical decision makers during the pandemic to ensure that medical treatment aligns with patient goals and values.

Authors+Show Affiliations

Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States.Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States.Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States.Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States.Department of Medicine, The Ohio State University College of Medicine, Columbus, OH, United States.Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States.Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States.Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States.

Pub Type(s)

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

Language

eng

PubMed ID

32716900

Citation

Portz, Jennifer D., et al. "Advance Care Planning Among Users of a Patient Portal During the COVID-19 Pandemic: Retrospective Observational Study." Journal of Medical Internet Research, vol. 22, no. 8, 2020, pp. e21385.
Portz JD, Brungardt A, Shanbhag P, et al. Advance Care Planning Among Users of a Patient Portal During the COVID-19 Pandemic: Retrospective Observational Study. J Med Internet Res. 2020;22(8):e21385.
Portz, J. D., Brungardt, A., Shanbhag, P., Staton, E. W., Bose-Brill, S., Lin, C. T., Kutner, J. S., & Lum, H. D. (2020). Advance Care Planning Among Users of a Patient Portal During the COVID-19 Pandemic: Retrospective Observational Study. Journal of Medical Internet Research, 22(8), e21385. https://doi.org/10.2196/21385
Portz JD, et al. Advance Care Planning Among Users of a Patient Portal During the COVID-19 Pandemic: Retrospective Observational Study. J Med Internet Res. 2020 08 11;22(8):e21385. PubMed PMID: 32716900.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Advance Care Planning Among Users of a Patient Portal During the COVID-19 Pandemic: Retrospective Observational Study. AU - Portz,Jennifer D, AU - Brungardt,Adreanne, AU - Shanbhag,Prajakta, AU - Staton,Elizabeth W, AU - Bose-Brill,Seuli, AU - Lin,Chen-Tan, AU - Kutner,Jean S, AU - Lum,Hillary D, Y1 - 2020/08/11/ PY - 2020/06/12/received PY - 2020/07/24/accepted PY - 2020/07/13/revised PY - 2020/7/28/pubmed PY - 2020/8/22/medline PY - 2020/7/28/entrez KW - COVID-19 KW - advance care planning KW - advance directives KW - electronic health records KW - health system KW - pandemic KW - patient portal KW - planning KW - web-based tool SP - e21385 EP - e21385 JF - Journal of medical Internet research JO - J. Med. Internet Res. VL - 22 IS - 8 N2 - BACKGROUND: Advance care planning is the process of discussing health care treatment preferences based on patients' personal values, and it often involves the completion of advance directives. In the first months of 2020, a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), began circulating widely in the American state of Colorado, leading to widespread diagnosis of coronavirus disease (COVID-19), hospitalizations, and deaths. In this context, the importance of technology-based, non-face-to-face methods to conduct advance care planning via patient portals has increased. OBJECTIVE: The aim of this study was to determine the rates of use of a web-based advance care planning tool through a health system-based electronic patient portal both before and in the early months of the COVID-19 pandemic. METHODS: In 2017, we implemented web-based tools through the patient portal of UCHealth's electronic health record (EHR) for patients to learn about advance care planning and complete an electronically signed medical durable power of attorney (MDPOA) to legally appoint a medical decision maker. Patients accessing the portal can complete and submit a legally valid MDPOA, which becomes part of their medical record. We collected data on the patients' date of MDPOA completion, use of advance care planning messaging, age, sex, and geographic location during the early phase of the COVID-19 pandemic (December 29, 2019, to May 30, 2020). RESULTS: Over a 5-month period that includes the early phase of the COVID-19 pandemic in Colorado, total monthly use of the advance care planning portal tool increased from 418 users in January to 1037 users in April and then decreased slightly to 815 users in May. The number of MDPOA forms submitted per week increased 2.4-fold after the stay-at-home order was issued in Colorado on March 26, 2020 (P<.001). The mean age of the advance care planning portal users was 47.7 years (SD 16.1), and 2206/3292 (67.0%) were female. Women were more likely than men to complete an MDPOA, particularly in younger age groups (P<.001). The primary use of the advance care planning portal tools was the completion of an MDPOA (3138/3292, 95.3%), compared to sending an electronic message (148/3292, 4.5%). Over 50% of patients who completed an MDPOA did not have a prior agent in the EHR. CONCLUSIONS: Use of a web-based patient portal to complete an MDPOA increased substantially during the first months of the COVID-19 pandemic in Colorado. There was an increase in advance care planning that corresponded with state government shelter-in-place orders as well as public health reports of increased numbers of COVID-19 cases and deaths. Patient portals are an important tool for providing advance care planning resources and documenting medical decision makers during the pandemic to ensure that medical treatment aligns with patient goals and values. SN - 1438-8871 UR - https://www.unboundmedicine.com/medline/citation/32716900/Advance_Care_Planning_Among_Users_of_a_Patient_Portal_During_the_COVID_19_Pandemic:_Retrospective_Observational_Study_ L2 - https://doi.org/10.2196/21385 DB - PRIME DP - Unbound Medicine ER -