Data Collection and Outcomes
death, 99497
SECONDARY
EHR data were extracted over the study period; additional 2 weeks of data after the conclusion of the notification were included to provide time for providers to act on the notification. These data included provider action to notification (dismiss, acknowledge, and refer patient to study) and any free-text notification comments; patient demographics (age at start of study period, sex, race, and ethnicity); health care utilization (primary care visits and hospitalizations during notification period); primary insurance payor, ambulatory referrals to hospice, and death; and ACP documentation. ACP documentation included ACP notes; legal documents uploaded to the EHR, such as advance directives, health care power of attorney forms, or Physician Orders for Life-Sustaining Treatment (POLST) forms; or the use of ACP billing codes (Current Procedural Terminology [CPT] 99497 and 99498). No specific template was recommended for ACP note documentation; health system templates were available and Epic SmartPhrase codes were used to track documentation in the medical record [Our primary outcome was referral to the study through the EHR notification. Our secondary outcomes were documentation of ACP in the EHR, as indicated by the presence of ACP notes, and usage of related billing codes.