Use of an Ambulatory Patient Portal for Advance Care Planning Engagement.
Academic Medical Centers
/ organization & administration
Advance Care Planning
/ organization & administration
Aged
Aged, 80 and over
Ambulatory Care Facilities
/ organization & administration
Electronic Mail
Female
Health Services for the Aged
/ organization & administration
Humans
Male
Patient Participation
/ methods
Patient Portals
Pilot Projects
Quality Improvement
Advance Care Planning
Advance Directives
Doctor Patient Relations
Electronic Health Records
End of Life Care
Internet
Patient Participation
Primary Health Care
Quality Improvement
Workflow
Journal
Journal of the American Board of Family Medicine : JABFM
ISSN: 1558-7118
Titre abrégé: J Am Board Fam Med
Pays: United States
ID NLM: 101256526
Informations de publication
Date de publication:
Historique:
received:
16
01
2019
revised:
06
06
2019
accepted:
21
06
2019
entrez:
10
11
2019
pubmed:
11
11
2019
medline:
15
9
2020
Statut:
ppublish
Résumé
Primary care clinics need sustainable, population-based approaches to engage patients in advance care planning (ACP). Patient portal-based ACP tools may provide an option for patient engagement. To increase ACP outcomes by engaging older adults through portal-based ACP tools, including an electronic Medical Durable Power of Attorney (MDPOA) form. Geriatric clinic pilot of a multi-modal population-based outreach strategy for portal-based ACP tools. Outreach was to patients (n = 105) who were 65 years and older with an active portal account, no cognitive impairment, and no MDPOA on file. Patients received a motivational message via the portal and, if not read within 2 weeks, a mailed postcard about the portal-based ACP tools. Primary outcome was composite of any ACP action at 1-year including 1) new advance directive (AD) in the electronic health record, 2) use of portal-based ACP tools, or 3) documented ACP discussion with a provider. Sixty-five older adults read the electronic message at 12 months. Seventeen (16%) engaged in at least 1 ACP action. Fourteen of 17 engaged by adding an AD to their record. More patients completed an AD on article or brought a previously completed AD to clinic, compared with choosing to complete an electronic MDPOA via the portal. Brief motivational messages about ACP via a patient portal is feasible and may increase ACP outcomes for older adults in primary care. Future studies should evaluate population-based portal outreach strategies in combination with team-based workflows to enhance patient engagement in ACP.
Sections du résumé
BACKGROUND
Primary care clinics need sustainable, population-based approaches to engage patients in advance care planning (ACP). Patient portal-based ACP tools may provide an option for patient engagement.
OBJECTIVE
To increase ACP outcomes by engaging older adults through portal-based ACP tools, including an electronic Medical Durable Power of Attorney (MDPOA) form.
METHODS
Geriatric clinic pilot of a multi-modal population-based outreach strategy for portal-based ACP tools. Outreach was to patients (n = 105) who were 65 years and older with an active portal account, no cognitive impairment, and no MDPOA on file. Patients received a motivational message via the portal and, if not read within 2 weeks, a mailed postcard about the portal-based ACP tools. Primary outcome was composite of any ACP action at 1-year including 1) new advance directive (AD) in the electronic health record, 2) use of portal-based ACP tools, or 3) documented ACP discussion with a provider.
RESULTS
Sixty-five older adults read the electronic message at 12 months. Seventeen (16%) engaged in at least 1 ACP action. Fourteen of 17 engaged by adding an AD to their record. More patients completed an AD on article or brought a previously completed AD to clinic, compared with choosing to complete an electronic MDPOA via the portal.
CONCLUSIONS
Brief motivational messages about ACP via a patient portal is feasible and may increase ACP outcomes for older adults in primary care. Future studies should evaluate population-based portal outreach strategies in combination with team-based workflows to enhance patient engagement in ACP.
Identifiants
pubmed: 31704762
pii: 32/6/925
doi: 10.3122/jabfm.2019.06.190016
pmc: PMC7039311
mid: NIHMS1555080
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
925-930Subventions
Organisme : NIA NIH HHS
ID : K76 AG054782
Pays : United States
Organisme : NCRR NIH HHS
ID : UL1 RR025780
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002535
Pays : United States
Informations de copyright
© Copyright 2019 by the American Board of Family Medicine.
Déclaration de conflit d'intérêts
Conflict of interest: none declared.
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