Advanced Care Planning
Conditions
Keywords
Advance Care Planning, Mild Cognitive Impairment, Dementia, Patient Portal
Brief summary
The purpose of this research is to examine the feasibility of using a patient portal based advance care planning (ACP) tool to improve ACP discussions and documentation in persons living with cognitive impairment in outpatient primary care.
Detailed description
The goal of this study is to explore whether sending a portal-based ACP tool (called ACPVoice) paired with a motivational message within the patient portal before a routine primary care physician visit can improve ACP discussions and documentation within the electronic health record among persons living with cognitive impairment in outpatient primary care.
Interventions
BEHAVIORALAdvance Care Planning Tool - ACPVoice
Eligible patients will be sent a secure MyChart message with a motivational message asking them to complete the advance care planning tool (ACPVoice) with their care partner/surrogate decision-maker or loved one before their upcoming primary care visit. The ACPVoice tool will be attached electronically to the mychart message. A reminder message will be sent to an non-responders with a different motivational message.
BEHAVIORALStandard of Care for Advance Care Planning
Patients will have access to the standardized advance care planning questionnaires readily available already within their mychart account which is part of standard of care.
Sponsors
Wake Forest University Health Sciences
National Institute on Aging (NIA)
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age 65 years old and older * Diagnosis of recognized or probable mild cognitive impairment or mild dementia or elevated eRADAR score * Completed visit with their primary care provider (PCP) within the past 12 months and have upcoming PCP visit in next 6 months * Have an active patient portal account
Exclusion criteria
* Lives in a long-term care facility * Severe vision impairment/blindness (as they need to be able to read portal messages) * Enrolled in hospice * Lacks decisional capacity as deemed by PCP
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Engagement Rate | Up to month 6 | Percentage of participants who open the advance care planning tool (ACPVoice) mychart message |
| Percentage of Intervention Completion | Up to month 6 | In the ACPVoice arm, completion was defined as completion of the ACPVoice questionnaire following outreach through the patient portal and follow-up reminders. In the Standard of Care arm, completion was defined as completion of the standard Epic ACP questionnaire (ACP For My Care Team Questionnaire) available through the patient portal without additional prompting or outreach. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Advance Care Planning Documentation Rates by Primary Care Providers | 12 months pre intervention, up to month 6 post intervention | Number of participants with documentation of advance care planning within the electronic health record by primary care provider. Preintervention data collected from a chart review after participant enrolled in study. |
| Rate of Advance Care Planning Billing Code Usage | 12 months pre intervention, up to month 6 post intervention | Number of participants with advance care planning billing code usage (CPT codes 99497, 99498; HCPCS codes 1123, 1124). Data collected from a chart review after participant enrolled in study. |
| Rate of Documented Designated Surrogate Decision Maker | 12 months pre intervention, month 6 post intervention | Number of participants with a documented designated surrogate decision maker in the electronic health record. Data collected from a chart review after participant enrolled in study. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORJennifer Gabbard, MD
Wake Forest University Health Sciences
Baseline characteristics
| Characteristic | — |
|---|---|
| Age, Continuous | 80.53 years STANDARD_DEVIATION 8.36 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 2 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 148 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 1 Participants |
| Race (NIH/OMB) Asian | 2 Participants |
| Race (NIH/OMB) Black or African American | 39 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) White | 244 Participants |
| Sex: Female, Male Female | 185 Participants |
| Sex: Female, Male Male | 62 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 4 / 150 | 0 / 150 |
| other Total, other adverse events | 0 / 150 | 0 / 150 |
| serious Total, serious adverse events | 0 / 150 | 0 / 150 |
Outcome results
None listed