Impact of a Care Directives Activity Tab in the Electronic Health Record on Documentation of Advance Care Planning.
Impact of a Care Directives Activity Tab in the Electronic Health Record on Documentation of Advance Care Planning.
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DOI：
10.7812/tpp/15-103
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发表时间：
2016-01-01
影响因子：
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通讯作者：
Garrido, Terhilda
中科院分区：
文献类型：
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作者：
Turley, Marianne;Wang, Susan;Garrido, Terhilda
背景：为了确保以患者为中心的临终关怀，预先护理计划 (ACP) 必须记录在病历中，并在护理环境中轻松检索。目标：描述护理指示活动选项卡 (CDA) 的使用，这是电子健康记录中的一个单一位置功能，用于收集和查看住院和门诊护理环境中的 ACP 文档，并评估其与 ACP 文档记录率的关联。 2012 年和 2013 年，南加州凯撒医疗机构对 113,309 名 65 岁及以上在门诊或住院期间有 ACP 机会的患者进行了实施后分析。 主要结果指标：提供者的 CDA 使用率以及生命维持治疗的预先指示和医生医嘱的记录率，按 CDA 使用进行分层。 在门诊和住院患者中，使用 CDA 的患者与未使用 CDA 的患者相比，接受生命维持治疗的患者高出 3.5 至 9.6 个百分点。最大的差异是住院患者的生命维持治疗订单和门诊患者的预先指示；使用 CDA 的人比不使用 CDA 的人高出 9.6 个百分点。在控制年度变化后，所有差异均显着 (p < 0.001)。结论：使用和未使用 CDA 的患者之间的记录率存在统计学上的显着差异，表明电子健康记录中的标准化位置有可能改善 ACP 记录。需要进一步研究来了解 CDA 使用对偏好检索和临终关怀的影响。
CONTEXT: To ensure patient-centered end-of-life care, advance care planning (ACP) must be documented in the medical record and readily retrieved across care settings.OBJECTIVE: To describe use of the Care Directives Activity tab (CDA), a single-location feature in the electronic health record for collecting and viewing ACP documentation in inpatient and ambulatory care settings, and to assess its association with ACP documentation rates.DESIGN: Retrospective pre- and postimplementation analysis in 2012 and 2013 at Kaiser Permanente Southern California among 113,309 patients aged 65 years and older with ACP opportunities during outpatient or inpatient encounters.MAIN OUTCOME MEASURES: Providers' CDA use rates and documentation rates of advance directives and physician orders for life-sustaining treatments stratified by CDA use.RESULTS: Documentation rates of advance directives and physician orders for life-sustaining treatments among patients with outpatient and inpatient encounters were 3.5 to 9.6 percentage points higher for patients with CDA use vs those without it. The greatest differences were for orders for life-sustaining treatments among patients with inpatient encounters and for advance directives among patients with outpatient encounters; both were 9.6 percentage points higher among those with CDA use than those without it. All differences were significant after controlling for yearly variation (p < 0.001).CONCLUSION: Statistically significant differences in documentation rates between patients with and without CDA use suggest the potential of a standardized location in the electronic health record to improve ACP documentation. Further research is required to understand effects of CDA use on retrieval of preferences and end-of-life care.