Platts-Mills Timothy F, Richmond Natalie L, LeFebvre Eric M, Mangipudi Sowmya A, Hollowell Allison G, Travers Debbie, Biese Kevin, Hanson Laura C, Volandes Angelo E
1 Department of Emergency Medicine, University of North Carolina , Chapel Hill, North Carolina.
2 Division of Geriatric Medicine, Department of Medicine, University of North Carolina , Chapel Hill, North Carolina.
J Palliat Med. 2017 Jan;20(1):74-78. doi: 10.1089/jpm.2016.0243. Epub 2016 Sep 13.
Increasing advance care planning (ACP) among older adults is a national priority. Documentation of ACP in the electronic health record (EHR) is particularly important during emergency care.
We sought to characterize completion and availability of ACP among a subset of older patients at an academic emergency department (ED) with an integrated EHR.
In this cross-sectional study, patients were eligible if aged ≥80 years or aged 65-79 with ≥1 indicator of high risk for short-term mortality. Patient-reported completion of ACP and availability of ACP documentation in the EHR were assessed.
Among study patients (n = 104), 59% reported completing some form of ACP: living will 52%, heathcare power of attorney 54%, do not resuscitate 38%, and medical orders for scope of treatment or physician orders for life-sustaining treatment 6%. Whites were more likely to report having some form of ACP than minorities (66% vs. 37%, p < 0.01), as were patients aged ≥80 years than those aged 65-79 (79% vs. 44%, p < 0.01). Only 13% of all patients had either a current code status or any other current ACP documentation in the EHR. Among patients whose primary care provider uses the same EHR system as the study ED, only 19% had a current code status or any other ACP documentation in the EHR.
In a sample of older ED patients likely to benefit from ACP, few patients had documented end-of-life care preferences in the EHR.
在老年人中增加预先护理计划（ACP）是一项国家优先事项。在急诊护理期间，电子健康记录（EHR）中的ACP记录尤为重要。
我们试图描述在一家拥有集成EHR的学术急诊科（ED）中，一部分老年患者的ACP完成情况和可获取性。
在这项横断面研究中，年龄≥80岁或65 - 79岁且有≥1项短期死亡高风险指标的患者符合入选标准。评估患者自我报告的ACP完成情况以及EHR中ACP文件的可获取性。
在研究患者（n = 104）中，59%报告完成了某种形式的ACP：生前预嘱为52%，医疗保健委托书为54%，不要复苏为38%，治疗范围医疗指令或维持生命治疗医师指令为6%。白人比少数族裔更有可能报告有某种形式的ACP（66%对37%，p < 0.01），≥80岁的患者比65 - 79岁的患者更有可能（79%对44%，p < 0.01）。在所有患者中，只有13%在EHR中有当前的代码状态或任何其他当前的ACP文件。在其初级保健提供者与研究ED使用相同EHR系统的患者中，只有19%在EHR中有当前的代码状态或任何其他ACP文件。
在可能从ACP中受益的老年ED患者样本中，很少有患者在EHR中记录了临终护理偏好。
