advance care planning;
electronic health record;
medical home;
palliative care;
patient-centered care;
END-OF-LIFE;
CARE PLANNING DOCUMENTATION;
ADVANCE DIRECTIVES;
CHILDREN;
EXPERIENCE;
ADULTS;
D O I:
10.1089/jpm.2019.0630
中图分类号:
R19 [保健组织与事业(卫生事业管理)];
学科分类号:
摘要:
Objectives: An increasing number of children are living with complex chronic diseases (CCDs) due to medical advances. Despite a need for code status discussions (CSDs), there is great variability in the frequency and documentation of such conversations. The objective was to identify gaps in the documentation of CSDs within the electronic health record (EHR), focusing on patients with CCDs. Methods: This was a retrospective review of all patients admitted from the emergency department of a tertiary care children's hospital in 2016. An EHR query using the Apache Hadoop cluster and manual review identified documentation of CSDs, including (1) code status orders, (2) advance directives, and (3) CSDs in provider notes. Patient complexity was stratified using the Pediatric Medical Complexity Algorithm 3.0. Comparative analysis was performed using chi-square, Kruskal-Wallis tests and multivariable logistic regression. Results: There were 12,648 unique patients of whom 4157 (32.9%) had CCD. Only 209 (1.7%) patients had a code status documented, of whom 200 (95.7%) had CCD. Of 528 (4.2%) patients >= 18 years of age, 428 (81.1%) had CCD and only 65 (12.3%) had CSDs. Palliative care consultation increased odds of CSDs (OR: 21.4, 95% CI: 13.8-33.2, p < 0.0001), whereas African American race decreased odds of CSDs (OR: 0.42, 95% CI: 0.27-0.64, p < 0.0001). Conclusions: Among admitted pediatric patients, most do not have documentation of CSDs, including those with CCD and patients >= 18 years of age. Improvements in both frequency and consistency of CSD documentation are needed to inform the family-centered care of patients living with CCDs.
机构:
Columbia Univ Coll Phys & Surg, Div Pediat Crit Care Med, Dept Pediat, New York, NY 10032 USAColumbia Univ Coll Phys & Surg, Div Pediat Crit Care Med, Dept Pediat, New York, NY 10032 USA
Edwards, Jeffrey D.
Houtrow, Amy J.
论文数: 0引用数: 0
h-index: 0
机构:
Univ Pittsburgh, Dept Phys Med & Rehabil, Pittsburgh, PA USAColumbia Univ Coll Phys & Surg, Div Pediat Crit Care Med, Dept Pediat, New York, NY 10032 USA
Houtrow, Amy J.
Vasilevskis, Eduard E.
论文数: 0引用数: 0
h-index: 0
机构:
Vanderbilt Univ, Sch Med, Div Gen Internal Med & Publ Hlth, Nashville, TN 37212 USA
Vanderbilt Univ, Sch Med, Ctr Hlth Serv Res, Nashville, TN 37212 USA
Tennessee Valley Healthcare Syst, Geriatr Res Educ & Clin Ctr Serv, Dept Vet Affairs Med Ctr, Nashville, TN USA
Tennessee Valley Healthcare Syst, Clin Res Training Ctr Excellence, Dept Vet Affairs Med Ctr, Nashville, TN USAColumbia Univ Coll Phys & Surg, Div Pediat Crit Care Med, Dept Pediat, New York, NY 10032 USA
Vasilevskis, Eduard E.
Dudley, R. Adams
论文数: 0引用数: 0
h-index: 0
机构:
Univ Calif San Francisco, Div Pulm & Crit Care, San Francisco, CA 94143 USA
Univ Calif San Francisco, Dept Med, Philip R Lee Inst Hlth Policy Studies, San Francisco, CA USAColumbia Univ Coll Phys & Surg, Div Pediat Crit Care Med, Dept Pediat, New York, NY 10032 USA
Dudley, R. Adams
Okumura, Megumi J.
论文数: 0引用数: 0
h-index: 0
机构:
Univ Calif San Francisco, Div Gen Internal Med, San Francisco, CA 94143 USA
Univ Calif San Francisco, Dept Med, Philip R Lee Inst Hlth Policy Studies, San Francisco, CA USA
Univ Calif San Francisco, Dept Pediat, Div Gen Pediat, San Francisco, CA USAColumbia Univ Coll Phys & Surg, Div Pediat Crit Care Med, Dept Pediat, New York, NY 10032 USA
机构:
Childrens Hosp Philadelphia, Philadelphia, PA 19104 USAChildrens Hosp Philadelphia, Philadelphia, PA 19104 USA
Feudtner, Chris
Womer, James
论文数: 0引用数: 0
h-index: 0
机构:
Childrens Hosp Philadelphia, Philadelphia, PA 19104 USA
Temple Univ, Sch Med, Philadelphia, PA 19122 USAChildrens Hosp Philadelphia, Philadelphia, PA 19104 USA
Womer, James
Augustin, Rachel
论文数: 0引用数: 0
h-index: 0
机构:
Ctr Adv Palliat Care, New York, NY USAChildrens Hosp Philadelphia, Philadelphia, PA 19104 USA
Augustin, Rachel
Remke, Stacy
论文数: 0引用数: 0
h-index: 0
机构:
Univ Minnesota, Sch Social Work, Minneapolis, MN 55455 USAChildrens Hosp Philadelphia, Philadelphia, PA 19104 USA
Remke, Stacy
Wolfe, Joanne
论文数: 0引用数: 0
h-index: 0
机构:
Boston Childrens Hosp, Dana Farber Canc Inst, Div Pediat Palliat Care, Boston, MA USA
Boston Childrens Hosp, Dept Med, Boston, MA USAChildrens Hosp Philadelphia, Philadelphia, PA 19104 USA
Wolfe, Joanne
Friebert, Sarah
论文数: 0引用数: 0
h-index: 0
机构:
Akron Childrens Hosp, Haslinger Family Pediat Palliat Care Div, Akron, OH USAChildrens Hosp Philadelphia, Philadelphia, PA 19104 USA
Friebert, Sarah
Weissman, David
论文数: 0引用数: 0
h-index: 0
机构:
Ctr Adv Palliat Care, New York, NY USAChildrens Hosp Philadelphia, Philadelphia, PA 19104 USA
机构:
Columbia Univ Coll Phys & Surg, Div Pediat Crit Care Med, Dept Pediat, New York, NY 10032 USAColumbia Univ Coll Phys & Surg, Div Pediat Crit Care Med, Dept Pediat, New York, NY 10032 USA
Edwards, Jeffrey D.
Houtrow, Amy J.
论文数: 0引用数: 0
h-index: 0
机构:
Univ Pittsburgh, Dept Phys Med & Rehabil, Pittsburgh, PA USAColumbia Univ Coll Phys & Surg, Div Pediat Crit Care Med, Dept Pediat, New York, NY 10032 USA
Houtrow, Amy J.
Vasilevskis, Eduard E.
论文数: 0引用数: 0
h-index: 0
机构:
Vanderbilt Univ, Sch Med, Div Gen Internal Med & Publ Hlth, Nashville, TN 37212 USA
Vanderbilt Univ, Sch Med, Ctr Hlth Serv Res, Nashville, TN 37212 USA
Tennessee Valley Healthcare Syst, Geriatr Res Educ & Clin Ctr Serv, Dept Vet Affairs Med Ctr, Nashville, TN USA
Tennessee Valley Healthcare Syst, Clin Res Training Ctr Excellence, Dept Vet Affairs Med Ctr, Nashville, TN USAColumbia Univ Coll Phys & Surg, Div Pediat Crit Care Med, Dept Pediat, New York, NY 10032 USA
Vasilevskis, Eduard E.
Dudley, R. Adams
论文数: 0引用数: 0
h-index: 0
机构:
Univ Calif San Francisco, Div Pulm & Crit Care, San Francisco, CA 94143 USA
Univ Calif San Francisco, Dept Med, Philip R Lee Inst Hlth Policy Studies, San Francisco, CA USAColumbia Univ Coll Phys & Surg, Div Pediat Crit Care Med, Dept Pediat, New York, NY 10032 USA
Dudley, R. Adams
Okumura, Megumi J.
论文数: 0引用数: 0
h-index: 0
机构:
Univ Calif San Francisco, Div Gen Internal Med, San Francisco, CA 94143 USA
Univ Calif San Francisco, Dept Med, Philip R Lee Inst Hlth Policy Studies, San Francisco, CA USA
Univ Calif San Francisco, Dept Pediat, Div Gen Pediat, San Francisco, CA USAColumbia Univ Coll Phys & Surg, Div Pediat Crit Care Med, Dept Pediat, New York, NY 10032 USA
机构:
Childrens Hosp Philadelphia, Philadelphia, PA 19104 USAChildrens Hosp Philadelphia, Philadelphia, PA 19104 USA
Feudtner, Chris
Womer, James
论文数: 0引用数: 0
h-index: 0
机构:
Childrens Hosp Philadelphia, Philadelphia, PA 19104 USA
Temple Univ, Sch Med, Philadelphia, PA 19122 USAChildrens Hosp Philadelphia, Philadelphia, PA 19104 USA
Womer, James
Augustin, Rachel
论文数: 0引用数: 0
h-index: 0
机构:
Ctr Adv Palliat Care, New York, NY USAChildrens Hosp Philadelphia, Philadelphia, PA 19104 USA
Augustin, Rachel
Remke, Stacy
论文数: 0引用数: 0
h-index: 0
机构:
Univ Minnesota, Sch Social Work, Minneapolis, MN 55455 USAChildrens Hosp Philadelphia, Philadelphia, PA 19104 USA
Remke, Stacy
Wolfe, Joanne
论文数: 0引用数: 0
h-index: 0
机构:
Boston Childrens Hosp, Dana Farber Canc Inst, Div Pediat Palliat Care, Boston, MA USA
Boston Childrens Hosp, Dept Med, Boston, MA USAChildrens Hosp Philadelphia, Philadelphia, PA 19104 USA
Wolfe, Joanne
Friebert, Sarah
论文数: 0引用数: 0
h-index: 0
机构:
Akron Childrens Hosp, Haslinger Family Pediat Palliat Care Div, Akron, OH USAChildrens Hosp Philadelphia, Philadelphia, PA 19104 USA
Friebert, Sarah
Weissman, David
论文数: 0引用数: 0
h-index: 0
机构:
Ctr Adv Palliat Care, New York, NY USAChildrens Hosp Philadelphia, Philadelphia, PA 19104 USA