HealthDay News — According to a study published in the Journal of the American Geriatrics Society, quality improvement interventions can increase discussions relating to advanced care planning and the mention of advance directives (ADs) in the electronic medical record (EMR).

Norifumi Kamo, MD, from the Virginia Mason Medical Center in Seattle, and colleagues conducted an interrupted time series analysis with control groups in oncology, nephrology and primary care outpatient clinics. 

Data were included for all individuals aged 65 years and older with at least one office visit in any outpatient clinic (77,350 patients with 502,446 office visits). A series of quality improvement interventions were introduced to improve rates of advanced care planning discussions and capture these discussions in the EMR.

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The researchers found that, compared to visits in non-intervention primary care clinics, visits in the intervention primary care clinic were more likely to mention ADs in the EMR (53.4 versus 26.5%).

Compared with visits in other specialty clinics, visits in the intervention oncology and nephrology clinics were 8 and 2.5 times more likely to mention ADs in the EMR (49.3 versus 6.0% and 15.4 versus 6.0%, respectively).

“A series of quality improvement interventions to increase discussions about advance care planning and capture of advance care directives in the EMR significantly increased the rate of capture in primary care and specialty care outpatient settings,” the authors write.


Kamo N, et al. “Improving The Electronic Capture Of Advance Care Directives In A Healthcare Delivery System”. Journal of the American Geriatrics Society. 2017. doi: 10.1111/jgs.14695. [Epub ahead of print]

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