PT  - JOURNAL ARTICLE
AU  - Adreanne Brungardt
AU  - Andrea E. Daddato
AU  - Bennett Parnes
AU  - Hillary D. Lum
TI  - Use of an Ambulatory Patient Portal for Advance Care Planning Engagement
AID  - 10.3122/jabfm.2019.06.190016
DP  - 2019 Nov 01
TA  - The Journal of the American Board of Family
                Medicine
PG  - 925--930
VI  - 32
IP  - 6
4099  - http://www.jabfm.org/content/32/6/925.short
4100  - http://www.jabfm.org/content/32/6/925.full
SO  - J Am Board Fam Med2019 Nov 01; 32
AB  - Background: Primary care clinics need sustainable, population-based approaches to engage patients in advance care planning (ACP). Patient portal-based ACP tools may provide an option for patient engagement.Objective: To increase ACP outcomes by engaging older adults through portal-based ACP tools, including an electronic Medical Durable Power of Attorney (MDPOA) form.Methods: Geriatric clinic pilot of a multi-modal population-based outreach strategy for portal-based ACP tools. Outreach was to patients (n = 105) who were 65 years and older with an active portal account, no cognitive impairment, and no MDPOA on file. Patients received a motivational message via the portal and, if not read within 2 weeks, a mailed postcard about the portal-based ACP tools. Primary outcome was composite of any ACP action at 1-year including 1) new advance directive (AD) in the electronic health record, 2) use of portal-based ACP tools, or 3) documented ACP discussion with a provider.Results: Sixty-five older adults read the electronic message at 12 months. Seventeen (16%) engaged in at least 1 ACP action. Fourteen of 17 engaged by adding an AD to their record. More patients completed an AD on article or brought a previously completed AD to clinic, compared with choosing to complete an electronic MDPOA via the portal.Conclusions: Brief motivational messages about ACP via a patient portal is feasible and may increase ACP outcomes for older adults in primary care. Future studies should evaluate population-based portal outreach strategies in combination with team-based workflows to enhance patient engagement in ACP.