Elizabeth Walker|Ryan Mcmahan|Deborah E. Barnes|Mary Katen|Daniela Lamas|Rebecca L. Sudore
Advance Care Planning Documentation Practices and Accessibility in the Electronic Health Record: Implications for Patient Safety
University of California, San Francisco|University of California, San Francisco|San Francisco VA Medical Center|Brigham and Women's Hospital|San Francisco VA Medical Center
documenting patients advance care planning acp wishes essential providing valuealigned care documentation readily accessible little known acp documentation practices electronic health recordthe objective study describe acp documentation practices accessibility documented discussions electronic health recordparticipants primary care patients san francisco veterans affairs medical center 60 years old 2 chronicserious health conditions crosssectional study assessed prevalence acp documentation including legal formsorders discussions prior five years also determined accessibility discussions ie accessible centralized posting vs inaccessible free text progress notesthe mean age 414 participants 71 years sd 8 9 women 43 nonwhite 51 documented acp including 149 36 formsorders 138 33 discussions seventyfour participants 50 formsorders lacked accompanying explanatory documentation 55 discussions easily accessible including 70 documenting changes treatment preferences prior formsordershalf chronically ill older participants documented acp including onethird documented discussions however half patients completed legal formsorders accompanying documented explanatory discussions majority documented discussions easily accessible even wishes changed ensuring patients preferences documented easily accessible important patient safety quality improvement target ensure patients wishes honored