• Marianne Turley, Susan Wang, Di Meng, Michael Kanter, and Terhilda Garrido.
• Resource Manager of Analytics for the Data Information Management Enhancement Department of Kaiser Permanente Northwest in Portland, OR. marianne.c.turley@kp.org.
• Perm J. 2016 Jan 1; 20 (2): 43-8.

ContextTo ensure patient-centered end-of-life care, advance care planning (ACP) must be documented in the medical record and readily retrieved across care settings.ObjectiveTo describe use of the Care Directives Activity tab (CDA), a single-location feature in the electronic health record for collecting and viewing ACP documentation in inpatient and ambulatory care settings, and to assess its association with ACP documentation rates.DesignRetrospective pre- and postimplementation analysis in 2012 and 2013 at Kaiser Permanente Southern California among 113,309 patients aged 65 years and older with ACP opportunities during outpatient or inpatient encounters.Main Outcome MeasuresProviders' CDA use rates and documentation rates of advance directives and physician orders for life-sustaining treatments stratified by CDA use.ResultsDocumentation rates of advance directives and physician orders for life-sustaining treatments among patients with outpatient and inpatient encounters were 3.5 to 9.6 percentage points higher for patients with CDA use vs those without it. The greatest differences were for orders for life-sustaining treatments among patients with inpatient encounters and for advance directives among patients with outpatient encounters; both were 9.6 percentage points higher among those with CDA use than those without it. All differences were significant after controlling for yearly variation (p < 0.001).ConclusionStatistically significant differences in documentation rates between patients with and without CDA use suggest the potential of a standardized location in the electronic health record to improve ACP documentation. Further research is required to understand effects of CDA use on retrieval of preferences and end-of-life care.

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