Planning Documentation Research Articles

Transfer Pricing End-of-Year Adjustments in Korea

While Korean transfer pricing regulations legally allow year-end transfer pricing adjustments after the filing of a corporate tax return, it is advisable to adjust transfer prices throughout the fiscal year with a well-established business plan and robust transfer pricing documentation.

A cross-sectional study on advance care planning documentation attitudes during national advance care planning week in a South-East Asian country

BackgroundThrough advocacy initiatives such as roadshows during “National ACP Week”, the Agency for Integrated Care (AIC) had increased advance care planning (ACP) engagement since 2011. Project Happy Apples (PHA), a community initiative project led by medical students from the National University of Singapore, also conducted a public exhibition to raise ACP awareness during this period. This study aimed to investigate and identify predictors of attitudes towards ACP documentation among ‘ACP Week’ respondents which may be used to formulate strategies to increase ACP documentation in Singapore.MethodsA cross-sectional study on ACP documentation attitudes of 262 respondents during local roadshows were conducted. Multiple logistic regression models were built to investigate the associations between demographic variables and attitudes toward ACP documentation.ResultsThe mean age was 43.5 years (SD = 17.4), 79 (30.15%) were males and 49 (18.7%) were healthcare professionals (HCP). 117 (44.66%) respondents had prior experience with serious illness and 116 (44.27%) had heard of ACP. Age was a significant predictor of readiness to sign official papers naming nominated healthcare spokesperson (NHS) (OR = 1.04, 95%CI: 1.02–1.07). Experience with serious illness was a significant predictor of readiness to discuss end-of-life (EOL) care with healthcare professionals (HCP) (OR = 3.65, 95%CI: 1.36–11.61). Being female was a significant predictor for readiness to speak to their nominated healthcare spokesperson about EOL care (OR = 7.33, 95%CI: 2.06–46.73). Subgroup analyses revealed that those aged 20–39 were less likely to speak to their healthcare professional about or sign official papers regarding EOL care. We also found that being a healthcare professional does not necessitate better or worse attitudes.ConclusionAdvocacy programs tailored to targeting respondents of different age groups and prior experience with serious illness may improve the efficacy of advocacy efforts.

ENSURING ECONOMIC SECURITY AT THE LOCAL LEVEL

The article examines regional economic security. The authors determined that it is a certain value that is a general reflection of the state of various spheres of the state. It was determined that the mechanism for ensuring the economic security of the region should contribute to the strengthening of the security of the economy in various regions, the improvement of the regulation of economic growth by the state can help thanks to the preparation of regional and territorial planning documentation, the formation of a comprehensive concept of risk control, including the active monetary policy of the state. It was analyzed and determined in the study that a comprehensive analysis of regional economic security should be based on the concept of indicators that show the main aspects of the state of production, science, technology, investment, society, as well as the demographic situation in the region.

A Study to Determine Consensus for Nursing Documentation Reduction in Times of Crisis.

Nurses faced numerous challenges during the pandemic, particularly with the increased burden of electronic documentation. Surges in patient volume and visits led to rapid changes in nursing documentation, prompting diverse responses from regulatory and healthcare organizations. Nurses expressed safety concerns and struggled with changes, calling for national standards and regulatory support. Policy relaxations, such as the 1135 Waiver, sparked debate on the future of nursing care plan documentation. Using mixed-methods exploratory design, the study identified modifications of nursing documentation during crises, commonalities in documentation burden reduction for applicability beyond pandemics, and consensus on the definition of "surge." Documentation patterns were assessed from February to November 2022, involving 175 North American nurse leaders and informaticists. Data analysis included descriptive statistics, thematic analysis, and Pearson correlation coefficient. Significant differences were found between rural and urban settings (P = .02), with urban areas showing higher odds of changes to care plans (odds ratio, 4.889; 95% confidence interval, 1.27-18.78). Key findings highlighted the persistence of postcrisis documentation changes and varied definitions of surge criteria based on organizational leadership, policy, and mandates. The study yielded insights for modifying documentation, offering policy recommendations, and emphasizing ongoing collaboration and evidence-based approaches for future nursing practices.

Automated patient selection and care coaches to increase advance care planning for cancer patients.

Advance care planning/serious illness conversations can help clinicians understand patients' values and preferences. There are limited data on how to increase these conversations, and their effect on care patterns. We hypothesized that using a machine learning survival model to select patients for serious illness conversations, along with trained care coaches to conduct the conversations, would increase uptake in cancer patients at high risk of short-term mortality. We conducted a cluster-randomized stepped wedge study on the physician level. Oncologists entered the intervention condition in a random order over six months. Adult patients with metastatic cancer were included. Patients with <2 year computer-predicted survival and no prognosis documentation were classified as high-priority for serious illness conversations. In the intervention condition, providers received automated weekly emails highlighting high-priority patients and were asked to document prognosis for them. Care coaches reached out to these patients to conduct the remainder of the conversation. The primary endpoint was proportion of visits with prognosis documentation within 14 days. 6,372 visits in 1,825 patients were included in the primary analysis. The proportion of visits with prognosis documentation within 14 days was higher in the intervention condition than control condition: 2.9% vs 1.1% (adjusted odds ratio 4.3, p < .0001). The proportion of visits with advance care planning documentation was also higher in the intervention condition: 7.7% vs 1.8% (adjusted odds ratio 14.2, p < .0001). In high-priority visits, advance care planning documentation rate in intervention/control visits was 24.2% vs 4.0%. The intervention increased documented conversations, with contributions by both providers and care coaches.

Missed Opportunities for use of Advanced Care Planning and Palliative Care in Open Aortic Surgery

Major vascular surgery, including open aortic procedures, is associated with having a 30-day mortality rate greater than 6% and a perioperative complication rate greater than 50%. Published literature suggests that patients undergoing high-risk procedures benefit from having a care plan in place to not only maximize quality of life but also to ensure medical interventions align with care goals. Currently, there is a paucity of published data on the prevalence of goals of care conversations, advance care planning documentation, and palliative care evaluations in patients undergoing high-risk vascular operations. A retrospective chart review of all patients who underwent open aortic surgery at a tertiary care academic medical center from July 2014 to March 2023 was performed. Patient demographics, comorbidities, type and timing of advanced care planning (ACP), palliative care evaluations, and clinical outcomes during the periprocedural period were recorded. For patients who died during the study period, the use of palliative care prior to death were noted. Patients who received ACP or palliative care were compared with those who did not. The cohort consisted of 192 patients who underwent major open aortic surgery. The mean age was 63 years (SD 12.3) and the majority of patients were male (73.4%) and white (64.1%). Thirty-nine (20.6%) operations were classified as emergent. At the time of their operation, 16.7% (n=32) of patients had an ACP document on file. Of the 38 documents on file, most were durable power of attorney (DPOA) (86.8%) documents while a smaller percentage were physician orders for life-sustaining treatment (POLST) (13.2%). There were no patients with Do Not Resuscitate and/or Intubate (DNR/DNI), living will, or organ/tissue donation orders noted in their chart prior to surgery. One percent (n=2) of patients had a palliative evaluation prior to their operation. During the perioperative period, an additional 2 (1%) of patients had advanced care planning documentation and 7 (3.7%) of patients underwent palliative care evaluation. Fifteen percent of patients (n=28) died during the perioperative period and an additional 21 patients died by the end of the study period for a total mortality of 25.2% in the study population. Among patients that died during the perioperative period, 28.6% (n=8 out of 28) received palliative care. Overall, 28.6% of all study patients that died (n=14 out of 49) received a palliative care evaluation prior to or during their terminal hospitalization. Patients who had ACP documents or who received palliative care consultations prior to surgery were older (p=0.01), more likely to be on Medicare or Medicaid (p=0.004), and more likely to have a history of solid organ malignancy (p=0.03). The median interval between surgery and receiving palliative care was 20 (IQR 3-71) days. The median interval between palliative care and death was 5 (IQR 2-13) days. Patients who utilized ACP or PC were more likely to die at home (p=0.05). Despite a high mortality and morbidity rate, ACP documentation is poor for patients undergoing major open aortic surgery. Palliative care interventions tend to be performed closer to the end of life, suggesting a missed opportunity to define goals of care.

Abstract C005: Predictors of advance care planning documentation in female patients with breast cancer: A multilevel model analysis

Abstract Background: Advance care planning (ACP) is a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care. Likewise, ACP is associated with multiple benefits, such as lower rates of hospitalizations and reduced futile, aggressive cancer treatment at the end of life. However, ACP rates remain low in the U.S., especially for patients with advanced cancer. Despite being more likely to be diagnosed at advanced stages and hospitalized due to advanced cancer with poor prognosis, the Black and Hispanic/Latino populations continue to have meager rates of ACP. Research has shown that both individual-level and systems-level factors contribute to these racial disparities in ACP. Considering these disparities among vulnerable populations, interventions that increase ACP among minority patients with cancer are needed. Objective: To analyze using multilevel model analysis the predictors of ACP documentation in female patients with breast cancer over 5 years in the UChicago Health System. Methods: Using the Clinical Data Research Warehouse, this study included women diagnosed with breast cancer (N=7,814) from 2016 to 2021. Descriptive statistics were performed to characterize ACP, and potential differences in ACP rates among control variables were assessed using odds ratio (OR) estimations. Significantly correlated variables were included as covariates in the multivariate analyses through a logistic regression model. The multilevel random-effects (mixed-effects) model, using restricted maximum likelihood estimation, examined the pattern of ACP documentation; in the multilevel model, level 1 modeled the changes in individual ACP documentation, and level 2 included the between-subjects effects of the predictors of documentation. Results: 13.76% of women with breast cancer filled out at least one type of ACP documentation, 4.25% filled out the Power of Attorney, 5.75% filled out the Advance Directive, and 8.92% filled out the Code Status. Increasing age and being black/African-American seem to be related to an increased likelihood of completion of at least one type of ACP documentation. While increasing BMI and outpatient services seem to be related to a decrease in the likelihood of completing at least one type of ACP documentation. Conclusion: Understanding the factors related to ACP documentation will allow us to manage them and improve their completion. These results will help to inform the development of tools to increase the integration of ACP into care, especially those that are technology-based. Further work could include designing a predictive model to prioritize patients requiring ACP. Providing knowledge about ACP in nonclinical areas can lead to increased education about ACP and its benefits to families and communities. Citation Format: Andres Mauricio Garcia Sierra, Marcia Tan. Predictors of advance care planning documentation in female patients with breast cancer: A multilevel model analysis [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C005.

Quality of Advance Care Planning in Long-Term Care and Transfers to Hospital at the End Of Life

ObjectivesOur primary objective was to determine if more comprehensive advance care planning (ACP) documentation was associated with fewer transfers to hospital in the last year of life. Our secondary objective was to determine the impact of ACP processes and practices on hospital transfers in the last year of life. DesignRetrospective cohort study. Setting and ParticipantsLong-term care (LTC) residents in Ontario, Canada, 65 years and older who died between January 1, 2017, and May 30, 2018, and resided in a participating LTC home. MethodsWe administered a survey to directors of care at LTC homes inquiring about ACP practices. Our exposure of interest was living in a home with comprehensive ACP documentation that includes information beyond preferences for cardiopulmonary resuscitation and hospital transfer. Our primary outcome was the number of transfers to hospital in the last year of life. We fit negative binomial regression models to determine the independent effect of comprehensive ACP and other indicators of ACP quality. ResultsA total of 157 LTC homes with 6637 decedent residents were included in our study; 2942 lived in homes with comprehensive ACP documentation and 3695 had non-comprehensive ACP documents. Comprehensive documentation was not associated with fewer hospital transfers in the final year of life [incidence rat ratio (IRR), 1.00; 95% CI, 0.91–1.09]. ACP documentation update frequency, availability of ACP documents in the electronic medical record, referring to ACP documents during a health crisis, inclusion of resident values in ACP documents, and involvement of a multidisciplinary team were all associated with fewer transfers to hospital during follow-up in the last year of life. Conclusions and ImplicationsACP documents that contain information beyond preferences for cardiopulmonary resuscitation and hospital transfer had no association with transfers to hospital, but high-quality ACP practices and processes were associated with fewer transfers.

Rediscovering Valley Hillslopes: Their Forms, Uses, and Considerations in Urban Planning Documents

Re-considering the interactions between society and natural resources is fundamental in pursuing sustainability and adaptation to climate change in cities. The representation in urban planning instruments reveals an inadequate consideration of valley hillslopes as interface systems or as ‘places’ with possible multiple roles and meanings for populations. Beyond landslide and flooding considerations, valley hillslopes are scarcely identified as distinct entities from the valley and the plateau, investigated as sites of diverse possible uses, and analysed in terms of which variables related to the relief’s forms influence their use. Confronting urban planning instruments that reduce slopes to building spaces, this contribution advocates for a specific representation of valley hillslopes, highlighting the environment’s variety within which the system interacts, the diversity of uses, and the interrelationships between form and land cover. By combining GIS mapping and statistical analysis, this research proposes a multi-scalar approach based on identifying valley hillslopes delineated through minimum units (geochore), integrated with land cover clustering and an analysis of the potential relations between land cover and six explanatory variables. The research points out the singularity and complexity of valley hillslopes, which should be incorporated into urban planning policy as potential cultural, ecological, or recreational resources for populations.

Determining awareness of and readiness for standardized nursing languages in a mid-level midwestern hospital and associated school of nursing.

The purpose of this study was to examine knowledge, attitude, and barriers toward care planning documentation practices with standardized nursing languages (SNLs) of nurses and nursing students at a midwestern healthcare system, comparing student and nurse responses. Cross-sectional surveys were given over a 2-month period with nurses and nursing students at different sites in a midwestern healthcare system, using convenience sampling. The Knowledge, Attitude, and Barriers to Using Standardized Nursing Languages and Current Practices Survey was adapted for use and re-tested for validity/reliability (Content Validity Index 0.81-1.00; Cronbach alpha=0.82-0.99) with 28 Likert scale items measuring knowledge, attitude, and barriers. Descriptive statistics, composite scores, correlations, t-tests, and multiple regression were used to analyze the concepts of the tool. 134/400 RNs responded (34%); 109/116 students responded (93.9%). Data analyses indicate adequate to superior levels of knowledge related to SNLs and NANDA International, Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC), collectively referred to as NNN (NANDA, NIC, & NOC), positive attitudes toward SNLs/NNN and for adopting SNLs/NNN into documentation practices, but moderate to great barriers for implementation in practice. Barriers included lack of financial resources for change, lack of mentors, and lack of mandates to use SNLs. Students scored significantly higher than nurses in attitude only. Perceptions of nurses and student nurses for current documentation indicate awareness of inadequacy in existing systems and willingness to change existing systems for standardized languages, with perceived barriers to change/implementation of SNLs. Students were more positive about SNLs than nurses. Major implications for nursing are to reevaluate electronic documentation systems and determine how to insert and easily apply SNLs in these systems, such that nursing care documentation is standardized, interoperable, effective, time-saving, and attainable.

Action plans increase advance care planning documentation and engagement among English and Spanish-speaking older adults.

Advance care planning (ACP) has been reconceptualized as a health behavior. Action plans (APs), or patient-directed mini contracts, improve behavior change. However, no prior studies have assessed whether APs can increase ACP documentation and engagement. We included English and Spanish-speaking primary care patients from San Francisco, ≥55 years of age, with ≥2 serious or chronic illnesses. Participants were in the intervention arm of the PREPAREforYOURcare.org trial and asked at baseline to choose 1 of 5 actions (e.g., choose a surrogate). At 6 months, we assessed whether participants completed their AP and if completion was associated with demographics, electronic health record (EHR) ACP documentation, and five-point ACP Engagement Survey scores. We used t-tests, chi-squared, multivariate analysis adjusted for baseline ACP and clustering by physician, and qualitative thematic analysis to explore reasons for non-completion. The mean age of 586 participants was 65 ± 10 years; 44.0% women, 45.9% Spanish-speaking, 31.4% had limited health literacy, and 43% completed an AP at 6 months; surrogate-related (47.4%), tell others about medical wishes (33.7%), ask clinicians questions (13.7%), and decide what matters most in life (5.2%). Participants with limited versus adequate health literacy were less likely to complete an AP (25.4% vs 35.9%, p = 0.01). Completing an AP was associated with greater ACP EMR documentation 49.8% vs 35.6%, p < 0.001 (adjusted odds ratio: 2.06; 95% CI [1.43-2.97]) and engagement (adjusted five-point scores [3.69; 95% CI 3.57-3.81 vs 3.10; 95% CI: 2.98-3.21], p < 0.001). Themes for non-completion included not being ready and logistical issues (e.g., surrogate deceased). Among English and Spanish-speaking older adults, creating an ACP AP resulted in greater documentation and engagement. APs may help facilitate ACP behavior change as part of effective ACP interventions. Additional support may be needed for patients with limited health literacy and those facing logistical barriers.

The Place of a City Master Plan among Territorial Planning Documents

The Place of a City Master Plan among Territorial Planning Documents

Using PURPOSE-T in clinical practice: A realist evaluation

AimTo explain how the clinical and organisational context influenced the way the Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE-T) is used by nursing staff to support their clinical judgement and decision making about care planning and delivery. MethodsA realist process evaluation was undertaken in a large acute hospital trust using mixed methods incorporating organisational policy review, staff semi-structured, ethnographic observation of clinical care and patient record review. Approximately 75 h of ethnographic field work involving 72 patients, 15 patient record reviews and 16 staff interviews were undertaken on 4 wards. FindingsFindings suggest PURPOSE-T assisted nurses differently depending on their level of experience. Those with less experience use it as an educational guide, while those with more experience made an initial clinical judgement and used PURPOSE-T as a safety net to ensure they hadn't missed anything. Nurses were concerned about demonstrating good documentation of assessment, care planning and delivery in order to underpin consistent communication about care and because they had an underlying fear of being blamed if things went wrong. There is an array of other contextual features that impact the planning and delivery of pressure area care that go beyond the use of PURPOSE-T alone, including systematic equipment provision, competing patient safety initiatives and rehabilitation requirements. ConclusionThe findings reinforce the assertion that PU-RAIs are complex interventions and could inform the development of a more integrated system of care which takes into account the contextual features associated with PU prevention in modern hospitals.

Clinical Audit on Accuracy and Timeliness of Patient Admission Notes to Improve Quality of Care at a Tertiary Care Hospital

Background: The accurate and timely completion of patient admission notes is crucial for high-quality patient care and effective communication among healthcare providers. In the Pulmonology ward, where patients with respiratory conditions receive specialized treatment, comprehensive and prompt documentation of admission information is paramount. The complexity of these conditions and potential for acute exacerbations make accurate and timely documentation even more critical for guiding appropriate interventions and ensuring patient safety. Methodology: This uni-disciplinary audit reviewed prospective admission records and associated data for each patient over one month, with a sample size of 75 patients. The initial audit was conducted from June to July 2023 in the Pulmonology ward of Bahawal Victoria Hospital, Quaid-e-Azam Medical College Bahawalpur. Following initial audit recommendations, a proforma on patient admission notes with pre-written variables was created and explained to house officers and postgraduate residents. A subsequent re-audit was conducted from September to October 2023 to compare results with the initial audit. Results: The audit findings indicated a need for improvement in the timeliness of patient attendance and the documentation of initial assessments, vital signs, and treatment plans. The re-audit suggested improvements in patient attendance timeliness and initial assessment with vital sign recordings. However, the treatment chart signatures, and postgraduate resident stamps still needed improvement. Conclusion: Implementing the suggested recommendations can enhance patient care and ensure compliance with established protocols. Regular monitoring and follow-up audits are recommended to evaluate the effectiveness of the changes.

Urban Transformation of the Dubrovnik Summer Villa Setting—From an Idyllic Landscape to an Overbuilt City

The landscape surrounding a summer villa is, in a morphological and experiential sense, an inseparable part of the villa and its garden. This research examines the level of preservation of the historic landscapes of eight summer villas in Dubrovnik and the level of their integration into the urban fabric of the contemporary city. The research methods used include the analysis of the relevant scientific literature as well as the analysis and interpretation of graphic materials, i.e., cadastral maps from the second half of the 19th century, orthophoto maps, and spatial planning documentation. In this paper, the immediate landscape in close vicinity to the summer villas is defined as the protective zone of a summer villa (PZSV). Although the original use and extent of the summer villa landscapes have rarely been preserved, it is possible to establish PZSVs in order to preserve, i.e., reinterpret, the setting of the summer villas, which is necessary to experience them in their totality. This research establishes the general principles that enable the identification of three general models of transformation of the summer villa landscape. Furthermore, this research develops possible scenarios for the enhancement of the summer villa landscape based on the identified models. These models and scenarios are generally applicable in the context of the protection and enhancement of the summer villa landscapes in of the south of Croatia.

A real-world evaluation of the effectiveness and Sufficiency of Current Emergency Department Preventative Strategies for Reducing Emergency Department revisits in a Canadian children’s hospital: a retrospective cohort study

BackgroundDespite asthma guidelines’ recommended emergency department preventative strategies (EDPS), repeat asthma-related emergency department (ED) visits remain frequent.MethodsWe performed a retrospective cohort study of children aged 1–17 years presenting with asthma to the Children’s Hospital of Eastern Ontario (CHEO) ED between September 1, 2014 – August 31, 2015. EDPS was defined as provision of education on trigger avoidance and medication technique plus documentation of an asthma action plan, a prescription for an inhaled controller medication or referral to a specialist. Logistic regression was used to identify factors associated with receipt of EDPS. We further compared the odds of repeat presentation to the ED within the following year among children who had received EDPS versus those who had not.Results1301 patients were included, and the mean age of those who received EDPS was 5.0 years (SD = 3.7). Those with a moderate (OR = 3.67, 95% CI: 2.49, 5.52) to severe (OR = 3.69, 95% CI: 2.50, 5.45) asthma presentation were most likely to receive EDPS. Receiving EDPS did not significantly reduce the adjusted odds of repeat ED visits, (OR = 0.82, 95% CI: 0.56, 1.18, p = 0.28).ConclusionsPatients with higher severity asthma presentations to the ED were more likely to receive EDPS, but this did not appear to significantly decrease the proportion with a repeat asthma ED visit. These findings suggest that receipt of EDPS in the ED may not be sufficient to prevent repeat asthma ED visits in all children.

THE RELATION OF SPATIAL PLANNING DOCUMENTATION TO GREEN OPEN PUBLIC SPACES IN BOSNIA AND HERZEGOVINA

&amp;lt;p&amp;gt;Open public spaces in urban and rural areas are essential because they encourage interaction between citizens and connect the built urban fabric. That is why the planning and maintenance of these spaces are vital and require constant improvement following modern man&amp;#039;s needs. For this reason, special attention must be paid to these areas when planning documents are in creating. This work investigates the relationship between planning practice in Bosnia and Herzegovina and green open public spaces. Given that Bosnia and Herzegovina has a specific planning system, spatial planning documentation of different spatial levels will be analyzed in the paper. The results should indicate ways of treating green open public spaces in the spatial planning process.&amp;lt;/p&amp;gt;

Improving Completion Rates, Accuracy and Online Upload of DNA CPR, Adults With Incapacity (AWI) and Hospital Anticipatory Care Plan (HACP) Documentation in Two Old Age Psychiatry Wards in NHS Fife

Improving Completion Rates, Accuracy and Online Upload of DNA CPR, Adults With Incapacity (AWI) and Hospital Anticipatory Care Plan (HACP) Documentation in Two Old Age Psychiatry Wards in NHS Fife

Improving Goal-Concordant Care in Intensive Care Unit Admissions from the Emergency Department in a Comprehensive Cancer Center

ContextAs patients approach the end of life, discussion of their treatment goals is essential to avoid unnecessary suffering and deliver care in a manner consistent with their overall values. ObjectivesImplement a multipronged approach to improve the rates of advance care planning (ACP) documentation among providers admitting patients with cancer to the intensive care unit (ICU) from the emergency department (ED). MethodsWe developed multiple interventions including the development of a best-practice advisory to alert providers when patients had previous do-not-resuscitate orders; standardization of ACP documentation; early oncologist involvement in goals-of-care conversations with patients; a survey of ED providers to identify barriers to success; and positive reinforcement strategies aimed at improving the rates of ACP documentation in patients admitted from the ED to the ICU. ResultsPrior to our interventions, only 13% of patients admitted to the ICU from the ED had ACP notes. This percentage increased to 90% by the last month of our project. ConclusionThrough our multipronged approach, we significantly improved the rates of ACP documentation among providers admitting patients from the ED to the ICU.

ЕВОЛЮЦІЯ ЛЬВІВСЬКИХ УКРІПЛЕНЬ XIV – XVII ст. ТА ЇХ ЛОКАЛІЗАЦІЯ НА СУЧАСНІЙ ТОПОГРАФІЧНІЙ КАРТІ

Complexes of urban fortifications are the basis for analyzing historical development of a settlement and developing urban planning documentation. Therefore, in 2014, as part of the publication “Atlas of Ukrainian Historic Towns, Volume1: Lviv”, the authors of the present article published a scheme-reconstruction of the localization of Lviv's historical defensive buildings based on a modern topographic basis. The format of the Atlas did not provide for a full justification of the work done. Hence, the purpose of the present article is to reveal the methodology of the tracing of Lviv fortifications on a modern topographic basis; to substantiate the received results on the localization of fortifications and to determine their evolution. Based on the analysis of the works of predecessors, bibliographic, cartographic, and iconographic sources, three separate historical complexes of Lviv fortifications are identified, and the evolution of the complex of fortifications of the 14th - 17th centuries is highlighted. As a result of combining the drawings of the first three lines of fortifications worked out by J. Witwicki and our results of tracing the fortifications, we have found the high accuracy of J. Witwicki's work. Based on the analysis of sources and archaeological research, we have clarified information in a number of flanking elements and in certain directions of the three lines of fortifications in Lviv. In order to supplement this work with the results of the work of a wide range of scholars, obtained during the twentieth and early twenty-first centuries, we have conducted a pre-project study, the results of which are embodied in the differentiated designation of lost, preserved, and archaeologically recovered fortifications of the 14th and 17th centuries on a modern topographic basis at the scale of 1:2000. As a result of tracing the bastion fortifications of the suburbs, the remains of fortifications from the projects of F. Getkant (1635) and J. Behrens (1678-1682) have been found in the topography and planning structure of the city, as illustrated in the reconstruction schemes.