School of Medicine, University of California San Diego, San Diego, California.
Palo Alto Medical Foundation Research Institute, Palo Alto, California.
J Am Geriatr Soc. 2018 Feb;66(2):327-332. doi: 10.1111/jgs.15145. Epub 2017 Oct 24.
BACKGROUND/OBJECTIVES: With the growing public demand for access to critical health data across care settings, it is essential that advance care planning (ACP) information be included in the electronic health record (EHR) so that multiple clinicians can access it and understand individuals' preferences for end-of-life care. Community-based palliative care programs often incorporate ACP services. This study examined whether a community-based palliative care program is associated with digitally extractable ACP documentation in the EHR.
Observational study using propensity score-weighted generalized estimation equations to examine patterns of digitally extractable ACP documentation.
Palo Alto Medical Foundation (PAMF), a multispecialty ambulatory healthcare system in northern California.
Individuals aged 65 and older with serious illnesses between January 1, 2013, and December 31, 2014 (N = 3,444).
Community-based palliative care program in PAMF.
Digitally extractable ACP in EHR.
We found that only 14% (n = 483) of individuals with serious illnesses had digitally extractable ACP in electronic health records. Of the 6% of individuals receiving palliative care, 65% had ACP, versus 11% of those not receiving palliative care. Study results showed a strong positive association between palliative care and ACP.
Only a small percentage of individuals with serious illnesses had ACP documentation in the EHR. Individuals with serious illnesses infrequently used palliative care delivered by board-certified palliative care specialists. Palliative care service use was associated with higher rates of ACP after controlling for organizational and individual characteristics using a propensity score weighting method. Scalable interventions targeted at non-palliative care clinicians for universal access to ACP are needed.
背景/目的：随着公众对跨医疗场所获取关键健康数据的需求不断增长，将预先医疗指示（ACP）信息纳入电子健康记录（EHR）中至关重要，以便多名临床医生能够访问这些信息并了解个人对临终关怀的偏好。社区为基础的姑息治疗项目通常会整合 ACP 服务。本研究旨在调查社区为基础的姑息治疗项目是否与 EHR 中可数字化提取的 ACP 文档相关。
采用倾向评分加权广义估计方程的观察性研究，以检查可数字化提取的 ACP 文档模式。
加利福尼亚州北部的帕洛阿尔托医学基金会（PAMF），一个多专科门诊医疗保健系统。
2013 年 1 月 1 日至 2014 年 12 月 31 日期间年龄在 65 岁及以上患有严重疾病的个体（n=3444）。
PAMF 的社区为基础的姑息治疗项目。
EHR 中的可数字化提取的 ACP。
我们发现，只有 14%（n=483）患有严重疾病的个体的电子健康记录中有可数字化提取的 ACP。在接受姑息治疗的 6%的个体中，有 65%的人有 ACP，而未接受姑息治疗的个体中，这一比例为 11%。研究结果表明，姑息治疗与 ACP 之间存在很强的正相关关系。
只有一小部分患有严重疾病的个体的 EHR 中有 ACP 文档。患有严重疾病的个体很少使用由董事会认证的姑息治疗专家提供的姑息治疗。在使用倾向评分加权方法控制组织和个体特征后，姑息治疗服务的使用与 ACP 的更高比率相关。需要针对非姑息治疗临床医生的可扩展干预措施，以实现普遍获得 ACP。
