Gundersen Lutheran Medical Foundation, 1836 South Avenue, La Crosse, WI 54601, USA.
J Am Geriatr Soc. 2010 Jul;58(7):1249-55. doi: 10.1111/j.1532-5415.2010.02956.x.
To determine whether outcomes have changed over time for a managed, systematic approach to advance care planning (ACP).
Retrospective comparison of medical record and death certificate data of adults who died over a 7-month period in 2007/08 with those of adults who died over an 11-month period in 1995/96.
All healthcare organizations in La Crosse County, Wisconsin.
Five hundred forty adults who died in 1995/96 and 400 adults who died in 2007/08.
A systematic ACP approach, Respecting Choices, collaboratively implemented in 1993 and continuously improved in subsequent years.
Demographic and cause-of-death data were collected from death certificates. Type and content of any advance directive (AD), existence and content of Physician Orders for Life-Sustaining Treatment, and medical treatment provided at the location of death in the last 30 days of life were abstracted from the medical record.
The recent data show a significantly greater prevalence of ADs (90% vs 85%, P=.02) and of availability of these directives in the medical record at the time of death (99.4% vs 95.2%, P<.001) than the data collected over 10 years ago. The new data suggest that quality efforts have improved the prevalence, clarity, and specificity of ADs.
A system for ACP can be managed in a geographic region so that, at the time of death, almost all adults have an advance care plan that is specific and available and treatment is consistent with their plan.
确定针对预先医疗指示（ACP）的管理系统方法的结果是否随时间而改变。
对 2007/08 年 7 个月期间死亡的成年人的病历和死亡证明数据与 1995/96 年 11 个月期间死亡的成年人的病历和死亡证明数据进行回顾性比较。
威斯康星州拉克罗斯县的所有医疗保健机构。
1995/96 年死亡的 540 名成年人和 2007/08 年死亡的 400 名成年人。
Respecting Choices 系统 ACP 方法于 1993 年协作实施，并在随后几年中不断改进。
从死亡证明中收集人口统计学和死因数据。从病历中提取任何预先医疗指示（AD）的类型和内容、是否存在和内容的医生生命维持治疗命令以及在生命的最后 30 天内的死亡地点提供的医疗。
最近的数据显示，AD 的流行率显著更高（90%对 85%，P=.02），并且在死亡时病历中更易获得这些指示（99.4%对 95.2%，P<.001），比 10 多年前的数据更多。新数据表明，质量改进措施提高了 AD 的流行率、清晰度和特异性。
可以在地理区域管理 ACP 系统，以便在死亡时，几乎所有成年人都有具体且可用的预先医疗计划，并且治疗与他们的计划一致。
