Differences in presenting advance directives in the chart, in the minimum data set, and through the staff's perceptions.
OBJECTIVE
Decisions concerning end-of-life care depend on information contained in advance directives that are documented in residents' charts in the nursing home. The availability of that information depends on the quality of the chart and on the location of the information in the chart. No research was found that compared directives by the manner in which they are collected and summarized in the chart. The goal of the proposed study was to clarify how advance directives are summarized in the patient's record and to clarify how physicians perceive the same advance directives and formal orders.


METHODS
The study involved 122 elderly persons who reside in one large (587 beds) nursing home. The authors collected data regarding the advance directives from three sources-Minimum Data Set (MDS), the front cover of the resident's chart, and from inside the chart.


RESULTS
The rates of documented advance directives found in this study are higher than those reported in the literature. Agreement rates between sources varied as a function of which sources were compared, as well as on the basis of which directive was examined. More specifically, the authors found higher rates of agreement between the information inside the chart and on the cover of the chart than between the MDS and the other two sources.


CONCLUSIONS
The reasons for discrepancies may lie in the different functions and procedures pertaining to these source documents.
Cohen-Mansfield
Jiska
J
Research Institute on Aging, Hebrew Home of Greater Washington, Rockville, MD 20852, USA. cohen-mansfield@hebrew-home.org
Libin
Alexander
A
Lipson
Steven
S
D016223:Advance Directives / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D016208:Databases, Factual; D005260:Female; D006801:Humans; D019451:Information Management / Q000379:methods; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data*; D008875:Middle Aged; D015995:Prevalence; D017064:Process Assessment, Health Care; D014481:United States