Study Design
RECRUITMENT
The Meta-LARC ACP study is a Patient-Centered Outcomes Research Institute (PCORI)–funded US-Canadian multisite cluster randomized trial comparing clinician-focused to team-based implementation of the Serious Illness Care Program (SICP) developed by Ariadne Labs. The clinician-based arm focused on the primary care clinician leading to ACP conversations, and the team-based arm used the primary care team (including nurses, medical assistants, and clinicians) to have ACP conversations [Within Duke Health, an EHR notification was developed to identify patients who would be appropriate for ACP, remind clinicians to have ACP, as well as to refer patients to the Meta-LARC ACP study. Duke Health is an academic health system serving urban, suburban, and rural populations in the Piedmont region of North Carolina. In the Duke Primary Care clinics, patients are assigned to a usual provider. If the provider is unavailable (eg, urgent same-day visit), then a patient may see any available provider.Six Duke Primary Care clinics participated—3 clinics in the clinician-based arm and 3 clinics in the team-based arm—from January 1, 2019, to January 31, 2021. Study recruitment was initially set to end in June 2020 but was extended through January 2021 due to the COVID-19 pandemic. A total of 45 clinicians were trained with Serious Illness Care Program, participated in the study, and received EHR notifications. This included 32 physicians (Doctor of Medicine or Doctor of Osteopathic Medicine), 11 advanced practice practitioners, and 2 population health nurses.The objectives of the Meta-LARC ACP Notification substudy are to (1) describe the implementation and usage of the EHR ACP notifications, (2) assess provider interactions with the EHR notifications, (3) evaluate the association of notifications with study referrals and with occurrence and documentation of ACP conversations, and (4) elicit provider perspectives on the EHR notification.