Moving “OurCareWishes” to the bedside: A step-wedge pragmatic trial

OBJECTIVE: Determine the effectiveness of a low-cost intervention, OurCareWishes (OCW), that encourages the use of a novel online advance care planning solution by patients admitted to the hospital. Specifically, we examined the impact of OCW interventions on the number of patients with advance care planning documentation recorded in the electronic medical record (EMR).

METHODS: We conducted a step-wedge pragmatic trial comparing patients who were encouraged to complete an online advance care planning form to standard of care. We collected standard of care AD (pre-implementation phase) and enhanced AD (intervention phase) data from 3 admission sites at a single large academic center. We used logistic regression to evaluate the association between receiving the enhanced AD process and presence of a new AD documented in the EHR within 8 weeks of hospital discharge.

RESULTS: In our final sample of 16,020 hospital admissions, only 8.6% (n = 1,370) of participants had an AD at the time of hospital admission and only 4.7% had a new AD 8 weeks after hospitalization. In our fully adjusted regression model, the completion of new ADs 8 weeks after hospitalization was not associated with exposure to the enhanced AD process (odds ratio 0.94; 95% CI 0.623, 1.42).

CONCLUSIONS: This step-wedge trial did not find a significant increase in AD documentation 8 weeks after hospital discharge after implementing an enhanced process for documenting AD with a web-based platform (OCW). We found low rates of AD on admission and 8 weeks after hospitalization, revealing low-hanging areas for improving AD documentation in future work.

Christopher Jones, Kirstin Manges, Teresa Tran, Casey Whitman