scholarly journals Advance Care Planning in A Preoperative Clinic: A Retrospective Chart Review

2019 ◽  
Vol 34 (4) ◽  
pp. 523-525 ◽  
Author(s):  
Shilpee Sinha ◽  
Rachel N. Gruber ◽  
Ann H. Cottingham ◽  
Barb Nation ◽  
Kathleen A. Lane ◽  
...  
Keyword(s):  
Advance Care Planning ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Care Planning ◽  
Advance Care

scholarly journals Advance Care Planning in a Geriatric Primary Care Clinic: A Retrospective Chart Review

2018 ◽  
Vol 36 (1) ◽  
pp. 24-27 ◽  
Author(s):  
Ariana Barkley ◽  
Mike Liquori ◽  
Amy Cunningham ◽  
John Liantonio ◽  
Brooke Worster ◽  
...  
Keyword(s):  
Primary Care ◽  
Advance Care Planning ◽  
Chart Review ◽  
Demographic Variable ◽  
Primary Care Clinic ◽  
Retrospective Chart Review ◽  
Care Planning ◽  
Power Of Attorney ◽  
Care Clinic ◽  
Advance Care

Purpose: Advance care planning (ACP) is theorized to benefit both the patient and their family when end of life is near as well as earlier in the course of serious illness. However, ACP remains underutilized, and little is known about the nature of ACP documentation in geriatrics practices. The study investigated the prevalence and nature of ACP documentation within a geriatric primary care clinic. Methods: A retrospective chart review was conducted on a randomly selected sample of electronic medical record (EMR) charts. The sample consisted of patients aged 65 and older who were seen in the clinic from January 1, 2015, to December 31, 2016. Charts were reviewed for ACP documentation and data regarding age, gender, race, religion, comorbidities (end-stage renal disease, congestive heart failure, cancer, and dementia), recent hospitalizations, and visit type. Results: Ninety-eight charts were reviewed (n = 98). Nine patients (9.18%) had an advance directive (AD) or power of attorney (POA) available within their EMR. Twenty-five patients (25.5%) had provider notes documenting that they have an AD, POA, or preferred health-care decision maker; however, no documents were available. The remaining 64 (65.3%) patients had no evidence of ACP documentation within their EMR. Age was the only demographic variable associated with completion of an AD ( P = .038). Discussion: The rate of ACP documentation (34.6%) was lower than the average among US adults aged 65 and over (45.6%); further, most patients with ACP documentation did not have an AD or POA on file. The authors plan to reevaluate ACP statistics in the same office following a future intervention.

Advance Care Planning and Healthcare Utilization in Patients With Amyotrophic Lateral Sclerosis: A Retrospective Chart Review

2021 ◽  
pp. 104990912110600
Author(s):  
Zachary Klock ◽  
Stephanie Dobak ◽  
Gail Houseman ◽  
Amy T. Cunningham ◽  
Margaret Kreher
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Healthcare Utilization ◽  
Advance Care Planning ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Care Planning ◽  
Advance Care ◽  
Lateral Sclerosis

Background: Amyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disorder resulting in functional decline and death. Despite recent emphases on advance care planning (ACP), low rates of documentation of ACP are seen in this population. Objectives: This study aims to determine rates of advance directive (AD) documentation and whether having a documented AD or ACP discussion affects healthcare utilization for ALS patients. Design: Retrospective chart review. Setting/Subjects: 130 patients from a multidisciplinary clinic at one U.S. tertiary care medical center. Measurements: The presence of a completed AD uploaded to the electronic medical record; the documentation of ACP discussions; and rates of percutaneous endoscopic gastrostomy (PEG) placement, tracheostomy placement, hospitalization within 2 weeks of death, death in hospital, and hospice utilization. Results: Overall rates of AD documentation in the electronic medical record were low at only 29.2%. Rates of PEG placement, tracheostomy placement, hospitalization within 2 weeks of death, death in hospital, and hospice utilization did not vary between patients with and without AD documentation. However, patients with a documented ACP conversation were more likely to have a PEG placed and to utilize hospice. Conclusions: Our study indicates that while having a documented AD is not correlated to differences in healthcare utilization in patients with ALS, the benefit of ACP in this population is in having a dedicated conversation with patients and caregivers rather than focusing on completion of a static document.

A single-center, retrospective chart review evaluating outpatient code status documentation in the EPIC electronic medical record for patients with advanced solid tumor cancer.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 242-242 ◽  
Author(s):  
John M. Horton ◽  
Michael Hwang ◽  
Joseph D. Ma ◽  
Eric Roeland
Keyword(s):  
Cancer Patients ◽  
Advance Care Planning ◽  
Solid Tumor ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Outpatient Setting ◽  
Care Planning ◽  
Advanced Solid Tumor ◽  
Code Status ◽  
Advance Care

242 Background: A desired code status is a critical element of advance care planning ideally outlined in an advance directive. Preferably, advance care planning occurs in the non-emergent, outpatient setting. In the absence of a documented code status, full resuscitation is the default, which is not desired by all patients. Currently, unlike the inpatient setting, there is no single, convenient location for code status documentation in the outpatient EPIC electronic medical record (EMR). In order to propose a system-wide solution, a retrospective chart review was completed to assess the scope of the problem. Methods: 160 charts were randomly selected of advanced solid tumor cancer patients (stage III-IV) who received care by a medical oncologist at the UCSD Moores Cancer Center from 2008-2011. The primary objective was to determine the incidence of code status documentation. Secondary objectives included determining the clinical role of the documenter and the code status documentation location within the EMR. Results: 57 advanced cancer patients (36%) had code status documented in 9 different locations in the EMR. Of the 57 patients, only 4 (7%) had a code status documented in the outpatient setting. When documented, code status was located in the progress note (5%), demographics tab (26%), problem list (2%), and scanned media section (14%). Out of the 160 charts, the outpatient oncologist documented the code status in 1 chart. Inpatient EMR locations of the code status included the discharge summary (33%), history and physical (11%), and progress note (9%). Conclusions: In the absence of a standard EPIC outpatient code status documentation procedure, code status was infrequently and inconsistently documented. Consequently, a readily available and accurate code status is not present for emergencies in the outpatient setting. With this information, we will focus future efforts on a clearly defined, standard, and convenient location for outpatient code status documentation in the EPIC EMR.

scholarly journals Advance care planning evaluation: a scoping review of best research practice

2021 ◽  
pp. bmjspcare-2021-003193
Author(s):  
Sophie Gloeckler ◽  
Tanja Krones ◽  
Nikola Biller-Andorno
Keyword(s):  
Advance Care Planning ◽  
Scoping Review ◽  
Retrospective Chart Review ◽  
Evidence Base ◽  
Future Research ◽  
Care Planning ◽  
Completion Rates ◽  
Future Care ◽  
Actual Care ◽  
Advance Care

Various indicators have been used to evaluate advance care planning, including completion rates, type of care received, and satisfaction. Recent consensus suggests, though, that receiving care consistent with one’s goals is the primary outcome of advance care planning and assessment should capture this metric. Goal concordant care is challenging to measure, and there is little clarity about how best to do so. The aim of this scoping review is to explore what methods have been used to measure goal concordant care in the evaluation of advance care planning. PubMed, Embase, PsycINFO, CINAHL and Cochrane were searched in September 2020 to identify studies that aimed to track whether advance care planning affected the likelihood of patients receiving care that matched their preferred care. 135 original studies were included for review. Studies used retrospective chart review (36%, n=49), questionnaire (36%, n=48) and interview (31%, n=42), focusing on both patients and proxies. Studies considered both actual care received (55%, n=74) and hypothetical scenarios anticipating possible future care (49%, n=66); some studies did both. While the reviewed studies demonstrate the possibility of working towards a solid methodology, there were significant weaknesses. Notably, studies often lacked enough reporting clarity to be reproducible and, relatedly, key concepts, such as end-of-life or preferred care, were left undefined. The recommendations that follow from these findings inform future research approaches, supporting the development of a strong evidence base to guide advance care planning implementation in practice.

Prevalence of advance care planning in a resident run clinic in an underserved community.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24067-e24067
Author(s):  
Swetha Ann Alexander ◽  
Vinay Mathew Thomas ◽  
David Wu ◽  
Radhika Kulkarni ◽  
William Rabitaille
Keyword(s):  
Primary Care ◽  
African American ◽  
Advance Care Planning ◽  
Primary Care Clinic ◽  
Retrospective Chart Review ◽  
Care Planning ◽  
Care Clinic ◽  
Underserved Community ◽  
Advance Care ◽  
End Stage

e24067 Background: Advance Care Planning (ACP) ensures that patients receive care that is in line with their values and preferences. ACP is best done in the outpatient setting. Despite recognizing the importance of ACP, the rates of ACP completion continue to be low. We conducted a retrospective study to determine the rates of ACP in a resident run primary care clinic in Hartford, Connecticut, which serves the underserved community. We looked at patient characteristics to find correlation with ACP completion. We also aimed to determine the reasons which could decrease the completion of ACP. Methods: This was a retrospective chart review. Patients who met any of the inclusion criteria [i) Age>65 ii) End stage renal disease on dialysis iii) Metastatic/Recurrent cancer iv) End stage heart failure v) COPD Gold stage D] and were seen in the primary care clinic from September 1, 2019 to December 31, 2019 were selected. Their charts were reviewed to see if ACP was documented during primary care visits over the past two years. The demographics of the patients were noted. Subsequently, a survey was distributed to residents to determine the possible causes of low rates of ACP discussion. Results: The characteristics of the 373 patients included in the study are shown in Table 1. Only 14 (3.8%) of the 373 had documentation of ACP during their primary care visits. The characteristics of the 14 patients in whom ACP was done are as follows: Sex- Female 9/14 (64%); Ethnicity- Hispanic 10/14 (71%), African American 4/14 (29%); Religious Affiliation- Christian 13/14 (93%), None 1/14 (7%); Married/Partner 2/14 (14%). Patient demographics including sex (p 0.6), religious beliefs (p 0.8), and marital status (p 0.6) did not show any correlation with the likelihood of ACP completion. Of the 31 residents who answered the survey, the most commonly listed barriers to ACP completion were the following: lack of time to conduct these discussions (94%), forgetting to conduct ACP discussions (48%), and lack of training (19%). All the residents believed that ACP discussion was beneficial to patients and medical providers. Conclusions: The rates of ACP planning in our clinic are much lower than the national average. African American and Hispanics, who make up the majority of our clinic population, traditionally have had low rates of ACP completion. This is an important issue that needs to be addressed. Advance care planning training should be also be strengthened during residency. [Table: see text]

Successful Advance Care Planning in a Rural Nursing Home

2018 ◽  
Vol 36 (5) ◽  
pp. 357-361 ◽  
Author(s):  
Judith Hold ◽  
Camille Payne ◽  
Jason Lesandrini ◽  
Avery Caz Glover
Keyword(s):  
Nursing Home ◽  
Advance Care Planning ◽  
Retrospective Chart Review ◽  
The United States ◽  
Completion Rate ◽  
Care Planning ◽  
Actual Process ◽  
Term Care ◽  
Advance Care ◽  
Family Choices

Background: Advance care planning (ACP) often culminates in the completion of advance care directives (ACD), which is a written record of informed decisions specifying the type and extent of desired medical treatment. Documentation of ACD in nursing homes in the United States indicates a 60% to 70% completion rate. There are little data on the time at which ACD are completed in relation to when the resident was admitted to the nursing home facility. Objective: To explore the success of advanced care planning at a large, rural long-term care (LTC) facility. Methods: A descriptive approach, using a retrospective chart review, of 167 residents was used to examine resident completion of health-care system documents, legal documents, predisposing factors (resident demographics and psychosocial characteristics), and the actual process of ACP as defined by the rural LTC facility. Results: This nursing home utilizes a document entitled resident preference for life-sustaining treatment (RPLST). For residents who do not have formal prepared advance directive documents, the RPLST serves to define resident and family choices for resuscitation and implementation of fluids, nutrition, medications, and antibiotics. The most striking finding was the completion rate of the RPLST within 100 days of being admitted to the nursing home. Conclusion: Documentation of end-of-life preferences within 10 days of admission was achieved through the incorporation of RPLST during the resident admission process.

Demenz aus palliativmedizinischer Perspektive: warum ein krankheitsspezifisches Advance Care Planning wichtig ist

2018 ◽  
Vol 75 (2) ◽  
pp. 105-111 ◽  
Author(s):  
Ralf J. Jox ◽  
Francesca Bosisio ◽  
Eve Rubli Truchard
Keyword(s):  
Palliative Care ◽  
Advance Care Planning ◽  
Care Planning ◽  
Advance Care ◽  
Menschen Mit Demenz

Zusammenfassung. Die Palliative Care muss sich im Zuge des demographischen Wandels vieler Gesellschaften rund um den Globus tiefgreifend wandeln. Sie muss mehr und mehr mit der Geriatrie zusammenarbeiten und geriatrische Expertise integrieren. Eine der zentralen Herausforderungen Geriatrischer Palliative Care ist die ethisch angemessene Therapieentscheidung für Menschen, die nicht mehr urteilsfähig sind. Nachdem der bisherige Ansatz herkömmlicher Patientenverfügungen erwiesenermassen enttäuscht hat, wird aktuell, gerade auch in deutschsprachigen Ländern, das systemische Konzept des Advance Care Planning (ACP) verfolgt. In diesem Artikel wird zunächst ACP mit seinen Zielen, Elementen und Effekten vorgestellt. Sodann wird gezeigt, weshalb es für Menschen mit Demenz eines adaptierten ACP-Programms bedarf und was ein solches demenzspezifisches ACP beinhalten muss.

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