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 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

Advance care planning in Hispanic/Latino and non-Hispanic white patients with cancer.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 10-10
Author(s):  
X Friedman ◽  
Veronica Cardenas ◽  
Sandahl Nelson ◽  
Paulette Gabbai-Saldate ◽  
Joseph Ma ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cancer Patients ◽  
Advance Care Planning ◽  
Cancer Type ◽  
Matched Pairs ◽  
Care Planning ◽  
Surrogate Markers ◽  
Code Status ◽  
Advance Care ◽  
Hispanic Latinos

10 Background: Advance care planning (ACP) is a process whereby patients communicate their end-of-life treatment preferences. Despite a growing US Hispanic/Latino population, much remains unknown regarding ACP for Hispanic/Latinos. This study examined the association between ethnicity and ACP, including individual surrogate markers—code status documentation, advance directive (AD)/physician order for life-sustaining treatment (POLST) completion, and/or palliative care (PC) consultation—in deceased Hispanic/Latino vs white non-Hispanic (WNH) cancer patients. Methods: A retrospective analysis was performed in randomly-selected, matched pairs of deceased (2011-2016) Hispanic/Latino and WNH cancer patients at an NCI-designated cancer center. Pairs were matched based on sex, age (at diagnosis/death), and cancer type. Conditional logistic regression was used to assess ethnicity (Hispanic/Latino vs WNH) and the presence any ACP (yes/no). Secondary aims examined the association between ethnicity and the presence of individual ACP surrogate markers using separate logistic regression models. All analyses were completed using SAS 9.4. Results: 152 eligible matched pairs were analyzed with no significant differences in presence of any ACP, code status documentation, or PC consultation. Cancer patients with AD/POLST completion were 58% less likely to be Hispanic/Latino than WNH. Conclusions: Historically, ACP in cancer care is difficult to implement with 20-30% penetrance across all racial/ethnic groups. This study suggests even lower rates of AD/POLST completion in Hispanic/Latino patients consistent with prior studies. However, based on the small sample size, these results are not generalizable and requires further evaluation. This study affirms the need for continued efforts to improve AD/POLST completion in Hispanic/Latinos. [Table: see text]

Advance care planning billing practices and documentation quality for cancer patients requiring hospitalization.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24000-e24000
Author(s):  
Callie Berkowitz ◽  
Jessica Ma ◽  
Jared Richard Lowe ◽  
Rowena Dolor
Keyword(s):  
Cancer Patients ◽  
Advance Care Planning ◽  
Successful Implementation ◽  
Care Planning ◽  
Oncology Patients ◽  
Code Status ◽  
Health Values ◽  
Documentation Quality ◽  
Advance Care ◽  
Healthcare Proxy

e24000 Background: Advance Care Planning (ACP) is an important component of comprehensive cancer care, yet barriers exist to successful implementation. In 2016, Medicare introduced billing codes to provide reimbursement for ACP discussions. Our aim was to evaluate the usage of ACP billing codes and quality of accompanying documentation in patients with a prior oncology admission at an academic medical center. Methods: Using an electronic health record data warehouse tool, we identified a cohort of cancer patients who had been admitted to the inpatient oncology service and had an ACP billing encounter (CPT codes 99497 or 99498) over a 4-year period (8/1/2016 to 8/1/2020). We collected patient and provider demographics and performed descriptive statistics. We assessed ACP documentation quality for 30 patients selected at random based on 5 domains (healthcare proxy, health values or goals, scope of treatment/code status, prognosis/illness understanding, and end of life [EOL]care planning/hospice) previously identified from a literature review. Results: We identified 170 unique patients (180 ACP encounters), representing a small fraction (170/5636, 0.03%) of hospitalized oncology patients over the study period. Patients were 52% female with mean age of 64 (SD 12.9). Mean number of oncology hospitalizations was 2.6 (SD 1.96). ACP encounters took place in both inpatient (135/180; 75%) and outpatient (45/180; 25%) settings. In the outpatient setting, the majority of billing encounters were in palliative care (27/45; 60%), followed by oncology (12/45;27%) and primary care (5/45;11%). Of the sample of patient charts reviewed (n = 30), provider documentation frequently included scope of treatment (27/30; 90%), prognosis (27/30; 90%), EOL planning (21/30; 70%), and health values (19/30, 63%); healthcare proxy was infrequently included (4/30, 13%). Conclusions: ACP billing remains infrequently utilized for a cohort of oncology patients requiring hospitalization at a large academic center. In cases for which an ACP discussion is billed, the accompanied documentation is of high clinical utility and meets several key quality domains. This work lays a foundation for future research and quality improvement efforts to improve ACP and documentation.[Table: see text]

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.

Improving communication about prognosis on an academic inpatient solid tumor oncology consult service.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 46-46
Author(s):  
Chrystal Ann Landry ◽  
Alaina J Kessler ◽  
Aarti Sonia Bhardwaj ◽  
Cardinale B. Smith
Keyword(s):  
Cancer Patients ◽  
Advanced Cancer ◽  
Advance Care Planning ◽  
Solid Tumor ◽  
Hospital Death ◽  
Care Planning ◽  
Post Intervention ◽  
Number Of Patients ◽  
Advance Care ◽  
The Impact

46 Background: As the number of patients living with cancer increases, a growing proportion of hospital inpatients will have an advanced cancer diagnosis. Data suggests that an unscheduled hospitalization for a patient with advanced cancer strongly predicts a median survival of less than 6 months. As hospitalists more frequently become the primary team taking care of admitted cancer patients, communication between a patient's oncologic care team and inpatient primary providers is crucial. We sought to implement and assess the impact of improved oncology consult documentation of patient prognosis on outcomes of advanced cancer patients admitted to our hospitalist medicine teaching services. Methods: We implemented an EMR-based oncology consult note template which required documentation of prognosis, potential future treatment options (if available), and advance care planning. We reviewed all patients with stage IV solid tumors admitted to the hospitalist teaching service for 8 weeks prior and 8 weeks post-template implementation for comparison. We utilized descriptive statistics and chi-squared testing as appropriate for analysis. Results: We evaluated 51 patients in the pre- and 36 patients in the post-intervention groups. Post-intervention, there was an improvement in documentation of prognosis (29.4% vs. 52.8%, p = 0.03), advanced care planning (37.2% vs. 83.3%, p < 0.0001), and in number of palliative care consults (58.8% vs. 83.3%, p = 0.02). On average, goals of care conversations occurred 2 days earlier in the post-intervention group (11 vs 9 days). Similarly, there was a decrease in inpatient chemotherapy administration (3 cases vs. 0), unit codes (2 vs. 0) and in-hospital death (23.5% vs. 11.1%). Conclusions: Creation of an oncology consult note template which incorporates current oncologic prognostic information improved documentation of prognosis and advance care planning as well as outcomes for advanced solid tumor oncology patients and enhanced inter-service communication. Based on these results, continued and targeted interventions are planned to further improve interservice communication.

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.

Standardizing documentation and improving communication on an academic inpatient solid tumor oncology consult service.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 171-171
Author(s):  
Chrystal Ann Landry ◽  
Alaina J Kessler ◽  
Aarti Sonia Bhardwaj ◽  
Cardinale B. Smith
Keyword(s):  
Cancer Patients ◽  
Advanced Cancer ◽  
Advance Care Planning ◽  
Solid Tumor ◽  
Hospital Death ◽  
Care Planning ◽  
Post Intervention ◽  
Number Of Patients ◽  
Advance Care ◽  
The Impact

171 Background: As the number of patients living with cancer increases, a growing proportion of hospital inpatients will have an advanced cancer diagnosis. Data suggests that an unscheduled hospitalization for a patient with advanced cancer strongly predicts a median survival of less than 6 months. As hospitalists more frequently become the primary team taking care of admitted cancer patients, communication between a patient's oncologic care team and inpatient primary providers is crucial. We sought to implement and assess the impact of improved oncology consult documentation of patient prognosis on outcomes of advanced cancer patients admitted to our hospitalist medicine teaching services. Methods: We implemented an EMR-based oncology consult note template which required documentation of prognosis, potential future treatment options (if available), and advance care planning. We reviewed all patients with stage IV solid tumors admitted to the hospitalist teaching service for 8 weeks prior and 8 weeks post-template implementation for comparison. We utilized descriptive statistics and chi-squared testing as appropriate for analysis. Results: We evaluated 51 patients in the pre- and 36 patients in the post-intervention groups. Post-intervention, there was an improvement in documentation of prognosis (29.4% vs. 52.8%, p = 0.03), advanced care planning (37.2% vs. 83.3%, p < 0.0001), and in number of palliative care consults (58.8% vs. 83.3%, p = 0.02). On average, goals of care conversations occurred 2 days earlier in the post-intervention group (11 vs 9 days). Similarly, there was a decrease in inpatient chemotherapy administration (3 cases vs. 0), unit codes (2 vs. 0) and in-hospital death (23.5% vs. 11.1%). Conclusions: Creation of an oncology consult note template which incorporates current oncologic prognostic information improved documentation of prognosis and advance care planning as well as outcomes for advanced solid tumor oncology patients and enhanced inter-service communication. Based on these results, continued and targeted interventions are planned to further improve inter-service communication.

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