Improving incidence of code status documentation through process and discipline

Area of Science:

• Oncology
• Healthcare Management
• Medical Informatics

Background:

• Advance care planning is crucial for documenting patient code status preferences.
• Code status documentation in outpatient settings, particularly community oncology, remains understudied.
• Existing methods have shown limited success in increasing documented code status.

Purpose of the Study:

• To evaluate the impact of a new advance care planning initiative on code status documentation in community oncology.
• To assess the effectiveness of the "My Choices, My Wishes" program in improving documentation rates.
• To analyze code status documentation incidence in patients with metastatic disease.

Main Methods:

• Implementation of the "My Choices, My Wishes" program across multiple US Oncology Network and McKesson Specialty Health sites.
• Systematic approach to learning and documenting patient values and goals of care in the electronic health record.
• Tracking code status documentation as a key performance measure over a 14-month period.

Main Results:

• Discrete code status documentation was achieved for 5,467 patients with metastatic disease between August 2013 and September 2014.
• The "My Choices, My Wishes" program demonstrated early promise in enhancing code status documentation rates.
• The initiative facilitated conversations about end-of-life care preferences in an outpatient oncology environment.

Conclusions:

• The "My Choices, My Wishes" program shows potential for improving code status documentation in outpatient oncology.
• Further efforts are needed to optimize advance care planning and documentation practices.
• Systematic approaches can enhance the integration of patient preferences into medical records.