A Cohort Study of Advance Directives in Electronic Health Records and End-of-Life Outcomes

IF 4.6 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society Pub Date : 2026-09-19 Epub Date: 2026-05-20 DOI:10.1111/jgs.70458

Danny L. Scerpella, David L. Roth, Erin R. Giovannetti, Jennifer L. Wolff

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引用次数: 0

Abstract

Background

Advance directives (ADs) are intended to document patient preferences for future care, including end-of-life (EOL). Knowledge of the impact of electronic health record (EHR)-documented ADs on actual care experiences is limited.

Participants and Setting

This is a retrospective cohort analysis of 2850 patients aged ≥ 65 years who died during a cluster-randomized trial of the impact of advance care planning (ACP). Subgroups included gender, marital status, patient portal access, dementia, and race. A total of 553 (19.4%) of the deceased patients had an EHR-documented AD 6 months prior to death. The setting was 51 primary care practices in two health systems in the Maryland and Washington, DC areas.

Methods

To examine the association between EHR-documented ADs and EOL experiences, a retrospective cohort study of older adults who died between September 2020 and October 2023 was conducted. Multilevel logistic regression models analyzed whether an EHR-documented AD at least 6 months before death was associated with potentially burdensome EOL care in the last 6 months of life and in-hospital death.

Results

Among 553 decedents who had an EHR-documented AD at least six months before death (mean [SD] age 82.5 (8.8)); 311 were women [56.2%]; 203 [36.7%] had a diagnosis of dementia, 128 (23.1%) were Black, and 400 (72.3%) were White [Correction added on 18 June 2026, after first online publication: The preceding sentence has been amended in this version.]. Patients with an AD in the EHR were less likely to experience potentially burdensome EOL care (110 (19.9%) vs. 616 (26.8%); aOR = 0.75) and in-hospital death (128 (23.2%) vs. 738 (32.1%); aOR = 0.69). Effects persisted both before and after adjusting for demographics, comorbidities, healthcare utilization, patient portal access, organization, and whether the clinic was randomized to the ACP intervention or control. Significant associations were observed in married patients and those with portal access, but not among patients with dementia or Black race.

Conclusions

In this cohort study, EHR-documented ADs were associated with reduced potentially burdensome EOL care and a lower likelihood of in-hospital death.

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电子健康记录中预先指示与临终结果的队列研究。

背景：预先指示（ADs）旨在记录患者对未来护理的偏好，包括生命终结（EOL）。关于电子健康记录（EHR）记录的ADs对实际护理经验的影响的知识有限。参与者和环境：这是一项回顾性队列分析，2850例年龄≥65岁的患者在预先护理计划（ACP）影响的集群随机试验中死亡。亚组包括性别、婚姻状况、患者门户访问、痴呆和种族。共有553例（19.4%）死亡患者在死亡前6个月有ehr记录的AD。该研究的背景是马里兰州和华盛顿特区两个卫生系统的51个初级保健实践。方法：为了研究ehr记录的ad与EOL经历之间的关系，对2020年9月至2023年10月期间死亡的老年人进行了一项回顾性队列研究。多水平logistic回归模型分析了死亡前至少6个月的ehr记录的AD是否与生命最后6个月的潜在EOL护理负担和院内死亡相关。结果：2850例死者（平均[SD]年龄82.5（8.8）岁）；女性311例，占56.2%；203例（36.7%）被诊断为痴呆，其中黑人787例（27.6%），白人1883例（66.1%）。在EHR中有AD的患者不太可能经历潜在的负担性EOL护理(110例（19.9%）对616例（26.8%）；aOR = 0.75)和院内死亡(128例（23.2%）对738例（32.1%）；aOR = 0.69)。在调整人口统计学、合并症、医疗保健利用、患者门户访问、组织以及诊所是否随机分配到ACP干预组或对照组之前和之后，效果都持续存在。在已婚患者和有门静脉通路的患者中观察到显著的相关性，但在痴呆患者或黑人中没有。结论：在这项队列研究中，ehr记录的ad与减少潜在的EOL护理负担和降低院内死亡的可能性相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.