Limitations
This substudy has a number of limitations. Less than a quarter of providers completed the electronic survey, and 1 provider provided half of the responses within the ACP notification. While response bias may limit conclusions drawn from provider perspectives on the notification, anecdotal provider feedback (from ongoing quarterly site visits conducted as part of the larger Meta-LARC study) has been similar to the feedback observed in the survey and comments. In addition, generalizability of the ACP score and notification may be limited. The EHR notification used an internally developed algorithm to identify primary care patients appropriate for ACP and is specific to our health system’s EHR (Epic) and its current user interface. Additional research is needed to validate the use of the ACP score among the primary care patient population, and this could also increase the generalizability of this algorithm to other primary care clinics within and potentially outside the health system. Lastly, the study design was limited to assessing the provider perspective on the ACP notification and did not collect data on the patient experience of care with the study providers. Future work as part of the Meta-LARC study will be evaluating the patient experience with ACP.