title: Impact of a Care Directives Activity Tab in the Electronic Health Record on Documentation of Advance Care Planning.
abstract: To ensure patient-centered end-of-life care, advance care planning (ACP) must be documented in the medical record and readily retrieved across care settings.
  
  
  
  To describe use of the Care Directives Activity tab (CDA), a single-location feature in the electronic health record for collecting and viewing ACP documentation in inpatient and ambulatory care settings, and to assess its association with ACP documentation rates.
  
  
  
  Retrospective pre- and postimplementation analysis in 2012 and 2013 at Kaiser Permanente Southern California among 113,309 patients aged 65 years and older with ACP opportunities during outpatient or inpatient encounters.
  
  
  
  Providers' CDA use rates and documentation rates of advance directives and physician orders for life-sustaining treatments stratified by CDA use.
  
  
  
  Documentation rates of advance directives and physician orders for life-sustaining treatments among patients with outpatient and inpatient encounters were 3.5 to 9.6 percentage points higher for patients with CDA use vs those without it. The greatest differences were for orders for life-sustaining treatments among patients with inpatient encounters and for advance directives among patients with outpatient encounters; both were 9.6 percentage points higher among those with CDA use than those without it. All differences were significant after controlling for yearly variation (p < 0.001).
  
  
  
  Statistically significant differences in documentation rates between patients with and without CDA use suggest the potential of a standardized location in the electronic health record to improve ACP documentation. Further research is required to understand effects of CDA use on retrieval of preferences and end-of-life care.
authors.affiliation: Resource Manager of Analytics for the Data Information Management Enhancement Department of Kaiser Permanente Northwest in Portland, OR. marianne.c.turley@kp.org.
authors.forename: Marianne
authors.initials: M
authors.lastname: Turley
authors.affiliation: Chief of Geriatrics and Palliative and Continuing Care at the West Los Angeles Medical Center in CA. susan.e.wang@kp.org.
authors.forename: Susan
authors.initials: S
authors.lastname: Wang
authors.affiliation: Director of Analytics and Evaluation of the Health Information Technology Transformation & Analytics Department of Kaiser Permanente in Oakland, CA. di.x.meng@kp.org.
authors.forename: Di
authors.initials: D
authors.lastname: Meng
authors.affiliation: Medical Director for Quality and Clinical Analysis for the Southern California Permanente Medical Group in Pasadena, CA. michael.h.kanter@kp.org.
authors.forename: Michael
authors.initials: M
authors.lastname: Kanter
authors.affiliation: Former Vice President of Health Information Technology Transformation & Analytics in Oakland, CA. terhilda@gmail.com.
authors.forename: Terhilda
authors.initials: T
authors.lastname: Garrido
mesh_terms: D032722:Advance Care Planning; D000368:Aged; D002140:California; D004282:Documentation; D057286:Electronic Health Records; D006801:Humans; D012189:Retrospective Studies; D014584:User-Computer Interface