{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T23:41:39Z","timestamp":1773272499152,"version":"3.50.1"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"e1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Objective To develop an information model for automating evaluation of concordance between patient preferences and end-of-life care.<\/jats:p><jats:p>Methods We modeled and validated 15 end-of-life care preference option domains, to which we mapped preferences recorded in standardized advance care planning documents and 232 end-of-life care events defined by procedure and medication codes. Patient preferences and end-of-life care events were available in electronic health records. Data from Kaiser Permanente Southern California modeling and testing populations were evaluated for concordance between patients\u2019 preferences and the end-of-life care events they experienced.<\/jats:p><jats:p>Results The information model successfully assessed concordance between patient preferences and end-of-life care events. Among 388 expired patients in the modeling population, 4164 care events occurred, 4100 (98%) of which were preference-concordant, and 64 (2%) of which were preference-discordant. Including end-of-life care events that did not occur increased the number of observations to 6029; 99% were preference-concordant. At the level of individuals, 72% (278) of patients experienced only preference-concordant care events, 13% (50) experienced at least one preference-discordant care event, and 15% (60) experienced no preference-related care events.<\/jats:p><jats:p>Discussion Model limitations pertain to assumptions that are required to match advance care planning documents with patient preference options and exclusion of preferred care that did not occur. Further research is required to apply the model to larger populations and to investigate the need for additional preference options.<\/jats:p><jats:p>Conclusion An information model for automating the assessment of the concordance between patients\u2019 advance care planning preferences and the end-of-life care they received was effective in a small population and has the potential to assess population-level preference-concordance on an ongoing basis.<\/jats:p>","DOI":"10.1093\/jamia\/ocv149","type":"journal-article","created":{"date-parts":[[2015,11,14]],"date-time":"2015-11-14T02:39:24Z","timestamp":1447468764000},"page":"e118-e124","source":"Crossref","is-referenced-by-count":14,"title":["An information model for automated assessment of concordance between advance care preferences and care delivered near the end of life"],"prefix":"10.1093","volume":"23","author":[{"given":"Marianne","family":"Turley","sequence":"first","affiliation":[{"name":"Health Information Technology Transformation and Analytics, Kaiser Permanente, Portland OR 97210, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Wang","sequence":"additional","affiliation":[{"name":"Southern California Permanente Medical Group, Los Angeles, CA 90027, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Di","family":"Meng","sequence":"additional","affiliation":[{"name":"Health Information Technology Transformation and Analytics, Kaiser Permanente, Oakland, CA 94612, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael H","family":"Kanter","sequence":"additional","affiliation":[{"name":"Southern California Permanente Medical Group, Pasadena, CA 91188, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Terhilda","family":"Garrido","sequence":"additional","affiliation":[{"name":"Health Information Technology Transformation and Analytics, Kaiser Permanente, Oakland, CA 94612, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2015,11,13]]},"reference":[{"key":"2020110612365994000_ocv149-B1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1056\/NEJMp038202","article-title":"Advance care planning","volume":"350","author":"Gillick","year":"2004","journal-title":"N Engl J Med."},{"key":"2020110612365994000_ocv149-B2","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1177\/1049909107302296","article-title":"End-of-life decisions: family views on advance directives","volume":"24","author":"Bernal","year":"2007","journal-title":"Am J Hosp Palliat Care."},{"key":"2020110612365994000_ocv149-B3","doi-asserted-by":"crossref","first-page":"c1345","DOI":"10.1136\/bmj.c1345","article-title":"The impact of advance care planning on end of life care in elderly patients: randomised controlled trial","volume":"340","author":"Detering","year":"2010","journal-title":"BMJ."},{"key":"2020110612365994000_ocv149-B4","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1200\/JCO.2009.25.4672","article-title":"End-of-life discussions, goal attainment, and distress at the end of life: predictors and outcomes of receipt of care consistent with preferences","volume":"28","author":"Mack","year":"2010","journal-title":"J Clin Oncol."},{"key":"2020110612365994000_ocv149-B5","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1111\/j.1532-5415.2000.tb02594.x","article-title":"Physician orders for life-sustaining treatment (POLST): outcomes in a PACE program","volume":"48","author":"Lee","year":"2000","journal-title":"J Am Geriatr Soc."},{"key":"2020110612365994000_ocv149-B6","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1046\/j.1532-5415.2002.50116.x","article-title":"Medical care inconsistent with patients' treatment goals: association with 1-year Medicare resource use and survival","volume":"50","author":"Teno","year":"2002","journal-title":"J Am Geriatr Soc."},{"key":"2020110612365994000_ocv149-B7","doi-asserted-by":"crossref","first-page":"4656","DOI":"10.1002\/cncr.25217","article-title":"Influence of patients' preferences and treatment site on cancer patients' end-of-life care","volume":"116","author":"Wright","year":"2010","journal-title":"Cancer."},{"key":"2020110612365994000_ocv149-B8","doi-asserted-by":"crossref","first-page":"1566","DOI":"10.1007\/s11606-007-0362-6","article-title":"The association between treatment preferences and trajectories of care at the end-of-life","volume":"22","author":"Cosgriff","year":"2007","journal-title":"J Gen Intern Med."},{"key":"2020110612365994000_ocv149-B9","doi-asserted-by":"crossref","first-page":"1722","DOI":"10.1111\/jgs.12450","article-title":"Preferences and actual treatment of older adults at the end of life","volume":"61","author":"Pasman","year":"2013","journal-title":"A mortality follow-back study. 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