Huber Michael Todd, Highland Janelle Deneen, Krishnamoorthi Venkatesan Ram, Tang Joyce Wing-Yi
1 Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA.
2 Center for Health and the Social Sciences, University of Chicago, Chicago, IL, USA.
Am J Hosp Palliat Care. 2018 Mar;35(3):532-541. doi: 10.1177/1049909117715217. Epub 2017 Jun 19.
Advance care planning may ensure care that is concordant with patient wishes. However, advance care plans are frequently absent when needed due to failure to engage patients in planning, inability to access prior documentation, or poor documentation quality. Interventions utilizing tools within the electronic health record (EHR) may address these barriers at the point of care. We aimed to identify EHR interventions previously utilized to improve advance care plans.
We systematically searched 7 databases for observational and experimental studies of EHR interventions associated with advance care plans. We abstracted information on the study populations, EHR and non-EHR components of the interventions, and the efficacy for advance care plan-related outcomes.
We identified 16 articles that contained an EHR intervention to improve advance care plans. Study populations, study designs, and EHR components of the interventions were heterogeneous. Documentation templates were the most common EHR tool reported (n = 8), followed by automated prompts (n = 7) and electronic order sets (n = 5). The most common reported outcomes were documentation of an advance care planning conversation in the EHR (n = 7) and the placement of code status orders (n = 7). All studies reporting efficacy (n = 9) demonstrated an improvement in 1 or more advance care planning outcomes.
The use of EHR interventions may improve advance care plan completion and availability at the point of care. Further work should seek to develop and evaluate standardized EHR tools for advance care planning.
预先护理计划可确保所提供的护理与患者意愿相符。然而，由于未能让患者参与计划制定、无法获取先前的文档记录或文档质量不佳，预先护理计划在需要时常常缺失。利用电子健康记录（EHR）中的工具进行干预可能会在护理点解决这些障碍。我们旨在确定先前用于改善预先护理计划的电子健康记录干预措施。
我们系统地检索了7个数据库，以查找与预先护理计划相关的电子健康记录干预措施的观察性和实验性研究。我们提取了有关研究人群、干预措施的电子健康记录和非电子健康记录组成部分以及与预先护理计划相关结果的疗效等信息。
我们确定了16篇包含改善预先护理计划的电子健康记录干预措施的文章。干预措施的研究人群、研究设计和电子健康记录组成部分各不相同。文档模板是报告中最常见的电子健康记录工具（n = 8），其次是自动提示（n = 7）和电子医嘱集（n = 5）。最常报告的结果是在电子健康记录中记录预先护理计划谈话（n = 7）和下达代码状态医嘱（n = 7）。所有报告有疗效的研究（n = 9）均表明1项或多项预先护理计划结果有所改善。
使用电子健康记录干预措施可能会改善护理点的预先护理计划完成情况和可用性。进一步的工作应致力于开发和评估用于预先护理计划的标准化电子健康记录工具。
