Community‐Based Palliative Care and Advance Care Planning Documentation: Evidence from a Multispecialty Group

Abstract

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. Design Observational study using propensity score–weighted generalized estimation equations to examine patterns of digitally extractable ACP documentation. Setting Palo Alto Medical Foundation (PAMF), a multispecialty ambulatory healthcare system in northern California. Participants Individuals aged 65 and older with serious illnesses between January 1, 2013, and December 31, 2014 (N = 3,444). Intervention Community‐based palliative care program in PAMF. Measurements Digitally extractable ACP in EHR. Results 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. Conclusion 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.