Provider Perspectives on Advance Care Planning Documentation in the Electronic Health Record: The Experience of Primary Care Providers and Specialists Using Advance Health-Care Directives and Physician Orders for Life-Sustaining Treatment.
Provider Perspectives on Advance Care Planning Documentation in the Electronic Health Record: The Experience of Primary Care Providers and Specialists Using Advance Health-Care Directives and Physician Orders for Life-Sustaining Treatment.
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DOI：
10.1177/1049909117693578
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发表时间：
2017-12
期刊：
影响因子：
--
通讯作者：
Tai-Seale M
中科院分区：
文献类型：
--
作者：
Dillon E;Chuang J;Gupta A;Tapper S;Lai S;Yu P;Ritchie C;Tai-Seale M
先进的护理计划（ACP）是由患者和临床医生的价值，但以一种可访问的方式记录ACP是有问题的。为了了解供应商如何将电子健康记录（EHR）ACP文件纳入临床实践中，我们采访了初级保健和专科部门的供应商关于ACP的做法（n=13），并分析了358初级保健提供者（PCP）和79名专家在一个大型多专业组的做法EHR数据。对初级保健、肿瘤科、肺病科和心脏科中ACP记录率较高和较低的13名提供者进行了结构化访谈。使用EHR问题列表中关于预先医疗保健指令（AHCD）和维持生命治疗医嘱（POLST）的数据来计算ACP记录率。在2013-2014年期间，检查了≥65岁的重症患者，提供者没有看到预先存在的ACP文件，79名专家中有88.6%（AHCD）和91.1%（POLST）的ACP文件为零。在358名PCP中，29.1%（AHCD）和62.3%（POLST）的ACP文件为零。接受采访的PCP通常认为ACP文件是有益且易于获取的，而专家通常不这样认为。专家对记录ACP表示更困惑，而PCP报告了标准的诊所工作流程。门诊病人和住院病人EHR系统之间的互操作性问题以及对谁应该记录ACP缺乏共识是实践中变化的来源。结果表明，供应商希望ACP讨论和文档的标准化工作流程。ACP的新医疗保险报销和越来越多的ACP质量指标激励医疗保健系统解决ACP文件的障碍。
Advance care planning (ACP) is valued by patients and clinicians, yet documenting ACP in an accessible manner is problematic. In order to understand how providers incorporate electronic health record (EHR) ACP documentation into clinical practice we interviewed providers in primary care and specialty departments about ACP practices (n=13), and analyzed EHR data on 358 primary care providers (PCPs) and 79 specialists at a large multispecialty group practice. Structured interviews were conducted with thirteen providers with high and low rates of ACP documentation in primary care, oncology, pulmonology, and cardiology departments. EHR problem list data on advance health care directives (AHCD) and physician orders for life-sustaining treatment (POLST) were used to calculate ACP documentation rates. Examining seriously ill patients ≥65 years with no pre-existing ACP documentation seen by providers during 2013–2014, 88.6% (AHCD) and 91.1% (POLST) out of 79 specialists had zero ACP documentations. Of 358 PCPs, 29.1% (AHCD) and 62.3% (POLST) had zero ACP documentations. Interviewed PCPs often believed ACP documentation was beneficial and accessible, while specialists more often did not. Specialists expressed more confusion about documenting ACP, whereas PCPs reported standard clinic workflows. Problems with interoperability between outpatient and inpatient EHR systems and lack of consensus about who should document ACP were sources of variations in practices. Results suggest providers desire standardized workflows for ACP discussion and documentation. New Medicare reimbursement for ACP and an increasing number of quality metrics for ACP are incentives for healthcare systems to address barriers to ACP documentation.
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影响因子：
3.1
作者：
Seymour J;Almack K;Kennedy S
通讯作者：
Kennedy S
DOI：
10.2215/cjn.11351015
发表时间：
2016-05-06
影响因子：
9.8
作者：
O'Hare, Ann M.;Szarka, Jackie;Vig, Elizabeth K.
通讯作者：
Vig, Elizabeth K.
影响因子：
2.9
作者：
KREFTING, L
通讯作者：
KREFTING, L
DOI：
10.1177/1049909106289080
发表时间：
2006-06-01
期刊：
The American journal of hospice & palliative care
影响因子：
--
作者：
Black, Kathy
通讯作者：
Black, Kathy
影响因子：
4.4
作者：
Gott, M.;Gardiner, C.;Ruse, C.
通讯作者：
Ruse, C.