Community-Based Palliative Care and Advance Care Planning Documentation: Evidence from a Multispecialty Group.
Community-Based Palliative Care and Advance Care Planning Documentation: Evidence from a Multispecialty Group.
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DOI：
10.1111/jgs.15145
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发表时间：
2018-03
影响因子：
6.3
通讯作者：
Ritchie C
中科院分区：
文献类型：
--
作者：
Tai-Seale M;Yang Y;Dillon E;Tapper S;Lai S;Yu P;Allore H;Ritchie C
随着公众对跨护理环境访问关键健康数据的需求不断增长，将预先护理计划（ACP）信息包括在电子健康记录（EHR）中以使得多个临床医生可以访问它们并了解患者对生命末期护理的偏好是至关重要的。以社区为基础的姑息治疗方案往往包括ACP服务。本研究旨在探讨是否以社区为基础的姑息治疗计划与数字提取ACP文档中的EHR。一项观察性研究，使用倾向评分加权广义估计方程来检查可数字提取的ACP文档的模式。帕洛阿尔托医学基金会（PAMF），一个位于北方加州的多专业门诊医疗保健系统。2013年1月1日至2014年12月31日期间，3，444例≥65岁的严重疾病患者的EHR记录。PAMF的社区姑息治疗计划。EHR中可数字提取的ACP。我们发现，在患有严重疾病的患者中，只有14%（3，444名患者中的483名）的电子健康记录中有可数字提取的ACP。在6%接受姑息治疗的患者中，65%患有ACP，而未接受姑息治疗的患者为11%。研究结果表明，姑息治疗和ACP之间存在很强的正相关。只有一小部分患有严重疾病的患者在EHR中有ACP文件。由委员会认证的姑息治疗专家提供的姑息治疗很少被患有严重疾病的患者使用。在使用倾向评分加权法控制组织和患者特征后，姑息治疗服务的使用与较高的ACP发生率相关。需要针对非姑息治疗临床医生的可扩展干预措施，以普及ACP。
with the growing public demand for access to critical health data across care settings it is essential that Advance Care Planning (ACP) information be included in the Electronic Health Record (EHR) so that multiple clinicians can access them and understand patients’ preferences for end-of-life care. Community-based palliative care programs often incorporate ACP services. This study examines whether a community-based palliative care program is associated with digitally extractable ACP documentations in the EHR. an observational study using propensity score weighted Generalized Estimation Equations to examine patterns of digitally extractable ACP documentation. the Palo Alto Medical Foundation (PAMF), a multispecialty ambulatory healthcare system in Northern California. EHR records of 3,444 patients ≥65, with serious illnesses, between January 1, 2013 and December 31, 2014. community-based palliative care program in PAMF. digitally extractable ACP in EHR. We found that only 14% (483 of 3,444) of patients with serious illnesses had digitally extractable ACP in electronic health records. Of the 6% of patients receiving palliative care, 65% had ACP versus 11% of patients without palliative care. Study results showed a strong positive association between palliative care and ACP. Only a small percentage of patients with serious illnesses had ACP documentations in the EHR. Palliative care delivered by board-certified palliative care specialists was used infrequently by patients with serious illnesses. Palliative care service use was associated with higher rates of ACP, after controlling for organizational and patient characteristics using propensity score weighting method. Scalable interventions targeted at non-palliative care clinicians for universal access to ACP are needed.
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影响因子：
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作者：
Turley, Marianne;Wang, Susan;Garrido, Terhilda
通讯作者：
Garrido, Terhilda
影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
DOI：
10.1093/jamia/ocw063
发表时间：
2017-01
期刊：
Journal of the American Medical Informatics Association : JAMIA
影响因子：
--
作者：
Downing NL;Adler-Milstein J;Palma JP;Lane S;Eisenberg M;Sharp C;Northern California HIE Collaborative;Longhurst CA
通讯作者：
Longhurst CA
影响因子：
4.4
作者：
Ahluwalia, S. C.;Fried, T. R.
通讯作者：
Fried, T. R.
影响因子：
3.1
作者：
Cox, Karen;Moghaddam, Nima;Seymour, Jane
通讯作者：
Seymour, Jane