ArticleBMJ health & care informatics2025
Impact of EHR direct-to-patient outreach on ambulatory advance directives completion among older adults.
Article in BMJ health & care informatics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAdvance directives (AD) are crucial for aligning healthcare with end-of-life preferences, yet documentation rates remain low, often only 5-15%. Leveraging electronic health records (EHRs) for automated outreach may offer a promising strategy to enhance AD completion without placing additional burdens on already busy clinicians.
methodsWe evaluated the feasibility and effectiveness of EHR-based AD outreach within the Yale New Haven Health System (YNHHS). In April 2024, a targeted message was sent via Epic's MyChart over seven business days, coinciding with National Healthcare Decisions Day. Patients aged ≥65 years with an active MyChart, no existing AD documentation and at least one primary care visit within 2 years were eligible; those hospitalised or in hospice were excluded. The message provided education about advance care planning, encouraged completion of a Healthcare Representative Form and/or Living Will Form and offered instructions for uploading documents directly to the EHR or returning them to a primary care provider's office. A reminder was sent 90 days later.
resultsOutreach reached 25 571 patients, with 61% viewing the MyChart message. Six months after intervention, AD completion across YNHHS rose from 39.9% (28 324/70 911) to 42.8% (30 230/70 583), translating to a 7.5% conversion rate in the targeted cohort. There was no observed increase in patient messaging or clinical staff workload.
conclusionThese findings suggest that EHR-integrated campaigns can effectively increase AD documentation among older adults without straining providers. By prompting patients to complete forms at their convenience, this scalable and sustainable intervention may be adapted for wider populations and other preventive or chronic care needs.
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