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Outcomes
1. Describe an electronic health record (EHR) alert for identifying and recruiting primary care patients for an advance care planning (ACP) study
2. Evaluate the use of EHR alert reminders for identifying and recruiting patients for an ACP study and ACP documentation in the EHR
Importance
The Meta-LARC advance care planning (ACP) study is a US-Canadian multicenter cluster randomized clinical trial comparing clinician-focused to team-based implementation of the Serious Illness Care Program toolkit in primary care (PC) clinics. At six study sites within one health system, an electronic health record (EHR) algorithm identified patients who may benefit from ACP and alerted providers to consider study referral.
Objective
Describe the use of an EHR alert by PC providers for ACP study referrals and documentation.
Methods
The EHR-based ACP algorithm included three criteria: age ≥70 years, comorbidities, and ≥2 hospitalizations in the past year. An EHR alert was triggered for patients with ≥2 criteria. Clinicians could close the alert or send a referral message to the study team after having an ACP conversation. Clinicians could also document ACP conversations in the EHR. ACP documentation was measured by ACP template use.
Results
Over 20 months, 2,877 patients (a total of 17,047 alerts, median 4 [IQR 2-8] alerts per patient) were identified by the ACP algorithm, resulting in 290 patient referrals. Of the patients identified, 435 patients (15%) had ACP notes documented by any health system provider, and 211 patients (7%) had ACP notes documented by a study-trained PC provider. Patients referred to the Meta-LARC ACP study were more likely to have ACP notes documented in the EHR (p < 0.001). Approximately one third of referred patients (n = 111) had ACP documentation in the EHR by a study PC clinician.
Conclusion
An EHR algorithm and alert can be used to identify patients appropriate for ACP, increase ACP conversations and documentation, and facilitate referrals for an ACP study in a PC setting.
Impact
While an EHR-based ACP alert is feasible in PC settings, additional research is needed to identify barriers and facilitators to improve the implementation and documentation of ACP.
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Copyright
© 2022 Published by Elsevier Inc.
