Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Aug 13, 2022
Date Accepted: Mar 21, 2023
Provider Interaction with an Electronic Health Record Notification to Identify Eligible Patients for a Cluster Randomized Trial of Advance Care Planning in Primary Care: A Secondary Analysis
ABSTRACT
Background:
Advance care planning (ACP) improves patient-provider communication and aligns care to patient values, preferences, and goals. Within a multi-site Meta-LARC ACP study, one health system deployed an EHR notification and algorithm to alert providers about patients potentially appropriate for ACP and the clinical study.
Objective:
To evaluate an electronic health record (EHR) notification for referring patients to an ACP study and engaging patients in ACP conversations and documentation.
Methods:
A secondary analysis assessed provider utilization and their response to the notification (e.g., acknowledge, dismiss, or engage patient in ACP conversation and refer patient to the clinical study).
Results:
Among the 2,877 patients identified by the EHR algorithm over 20 months, 17,047 unique notifications were presented to 45 providers in 6 clinics, who then referred 290 (10%) patients. Providers had a median of 269 [IQR 65 – 552] total notifications and patients had a median of 4 [IQR 2 – 8]. Patients with more (over 5) notifications were less likely to be referred to the study than those with fewer notifications (5.2% vs. 13.1%, P < .001). Providers who referred patients to the study were more likely to document ACP and submit ACP billing codes (P < .001).
Conclusions:
An EHR notification can be implemented to remind providers to both perform ACP conversations and refer patients to a clinical study. With diminishing returns after the fifth notification, optimization of EHR notifications for study referrals and ACP should consider provider workflow and alert fatigue to improve implementation and adoption. Clinical Trial: Clinicaltrials.gov NCT03577002
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