Development of ACP Notification Tool in the EHR
MAY
We used an ACP scoring system developed at Duke Health to identify patients who may benefit from an ACP conversation. The ACP score adds 1 point for each of the following: (1) age at or older than 70 years, (2) three or more prespecified comorbidities using Systematized Nomenclature of Medicine (SNOMED) clinical terms, and (3) two or more hospitalizations within the health system in the past year [Advance care planning (ACP) notification. Meta-LARC: Meta-network Learning and Research Center.From May 14, 2019, to January 14, 2021, the notification alerted enrolled providers when the patient presented for their clinic visit and the encounter visit was opened in the EHR. Once the notification appeared, providers were able to perform one of three actions: (1) dismiss the notification temporarily and have it retrigger when the chart was opened again in the same encounter, (2) acknowledge and remove the notification for the encounter, or (3) refer the patient to the study and commit to having an ACP conversation with the patient (Process map with advance care planning (ACP) notification process and provider actions. *ACP score identified patients who may benefit from an ACP conversation. There are a total of 3 points, with 1 point for each of the following: age at or older than 70 years, three or more prespecified comorbidities using Systematized Nomenclature of Medicine clinical terms, and two or more hospitalizations within the health system in the past year. Meta-LARC: Meta-network Learning and Research Center.Notifications that occurred outside of the 6 primary care clinics were excluded from the analysis (n=511). These excluded notifications occurred among providers (N=8) who had transitioned out of the primary care clinic and resident trainee providers (N=9) who also practiced outside of the primary care clinic (eg, inpatient medicine service).