Evaluation of an initiative to improve advance care planning for a home-based primary care service

BMC Geriatrics

Table 4 Presence of Advance Care Planning Documentation Among HomeViVE Home-Based Primary Care Patients, Before (N = 200) and After (N = 114) Palliative and Therapeutic Harmonization (PATH) Implementation

Documentation of key element on EMR	Before^a N = 200	After^a N = 114	p-value^b
Frailty stage documented^c, N (%)	54 (27.0%)	85 (74.6%)	<.0001
Substitute decision-maker documented^c, N (%)	127 (63.5%)	82 (71.9%)	0.128
Resuscitation decision documented^c, N (%)	159 (79.5%)	77 (67.5%)	0.018
Hospitalization decision documented^c, N (%)	123 (61.5%)	114 (100.0%)	<.0001
Mean (SD) composite documentation score^d	2.32 (1.16)	3.14 (1.11)	<.0001

HomeViVE Home Visits for Vancouver’s Elders home-based primary care program, EMR electronic medical record, SD standard deviation
^aBefore period: Active patients enrolled in program prior to June 20, 2017; After period: New consecutive patients enrolled between October 1, 2017 and May 1, 2018
^bTests of comparison included: two independent samples t-test for continuous data; Chi-square test or Fisher’s exact test for categorical data
^cDocumented – refers to the presence of documentation on key advance care planning decisions; these preferences are noted on the EMR face sheet, which is the front page of the EMR that contains crucial patient information such as patient identification and personal information, clinical information, and identification of family/substitute decision-maker
^dComposite documentation score – measure of overall documentation; each documented measure (frailty stage, substitute decision maker, resuscitation decision, hospitalization decision) is assigned one point if documented in the patient record; the composite score is the sum of all measures; score ranges from 0 to 4

ISSN: 1471-2318