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Abstract
Health care proxy (HCP) documentation is suboptimal. To improve rates of proxy selection and documentation, we sought to develop and evaluate a web-based interview to guide patients in their selection, and to capture their choices in their electronic health record (EHR). We developed and implemented a HCP interview within the patient portal of a large academic health system. We analyzed the experience, together with demographic and clinical factors, of the first 200 patients who used the portal to complete the interview. We invited users to comment about their experience and analyzed their comments using established qualitative methods. From January 20, 2015 to March 13, 2015, 139 of the 200 patients who completed the interview submitted their HCP information for their clinician to review in the EHR. These patients had a median age of 57 years (Inter Quartile Range (IQR) 45-67) and most were healthy. The 99 patients who did not previously have HCP information in their EHR were more likely to complete and then submit their information than the 101 patients who previously had a proxy in their health record (odds ratio 2.4, P = .005). Qualitative analysis identified several ways in which the portal-based interview reminded, encouraged, and facilitated patients to complete their HCP. Patients found our online interview convenient and helpful in facilitating selection and documentation of an HCP. Our study demonstrates that a web-based interview to collect and share a patient's HCP information is both feasible and useful.
Highlights
Written advance directives (ADs) in the form of living wills and health care proxies (HCP), allow patients to formalize their wishes for future health care before they reach decisional incapacity
Development of health care proxy interview We developed the HCP interview based on our prior experience with computer-based medical histories with advisors from Beth Israel Deaconess Medical Center (BIDMC)’s clinical, information systems, legal, and Conversation Ready teams as well as from patients.[16,17,18,20,36,37,38,39,40]
Ninety-nine (49.5%) of the patients who completed the interview did not have a HCP listed in their electronic health record (EHR) and of these, 78 (78.8%) submitted their HCP information for clinician review
Summary
Written advance directives (ADs) in the form of living wills and health care proxies (HCP), allow patients to formalize their wishes for future health care before they reach decisional incapacity. Having an AD in place increases the likelihood of a patient’s wishes being honored, often resulting in less aggressive care, lower cost[1] and less likelihood of death in the hospital.[2] Though studies have shown an increasing upward trend for patients having ADs,[3,4] the rate of implementation is still suboptimal.[5]. Commission on Accreditation of Healthcare Organizations have set requirements regarding ADs.[7] Despite policy work and clinicians’ understanding of the importance of patients having an AD, clinicians are often unable to spend adequate time with patients to guide them through advance care planning due to time and cost constraints.[8]. A recent study of Medicare beneficiaries showed that
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