Disseminating a Digital ACP Platform (Our Care Wishes) to Hospitalized Patients

Registration representatives (RR) from Silverstein 1 Admission Office, the Emergency
Department, and the Pre Admission Testing office will be administering the intervention at
the three sites. The current workflow is for the RR to provide all new admits with an
admission packet created by Guest Services and also ask ALL patients whether they have
completed an Advance Directive as mandated by the Patient Self-Determination Act of 1991 with
little attention paid to encouraging AD completion. During the control/baseline phase of this
trial, this workflow will remain the same.

During the intervention phase, a flyer describing the Our Care Wishes platform will be added
to the back pocket of admission packets for patients being admitted via the Silverstein 1
Admission Office and the Emergency Department and for patients being seen in the Pre
Admission Testing office. The interventions will vary slightly between Silverstein 1/PAT and
the Emergency Department given concern for limited bandwidth by RR in the ED setting.

For patients admitted through Silverstein 1 and who visit PAT, they will present to the RR
per usual and the RR will follow the current workflow. At the point where the RR asks the
patient if they have an AD and if it is present, the RR will remind the patient of the
importance of having a document that records their care wishes. The RR will then inform the
patient that Penn has created a free, online resource called Our Care Wishes to help patients
with Advance Care Planning. The platform allows patients to upload their wishes right into
PennChart using their MyPennMedicine login. The RR will then show the flyer in the back
pocket of the admission folder to the patient. For patients being admitted via Silverstein 1
Admission Office and those being seen in the Pre Admission Testing office, the RR will then
proceed to ask patients if they would like to be sent a link to Our Care Wishes by email or
text. For those patients who respond affirmatively, the RR will ask for the preferred email
or phone number and will then complete the necessary fields to refer on
www.ourcarewishes.org/refer.

For patients admitted through the Emergency Department, a weekly report will be created that
generates a list of admissions during the prior week along with their active PennChart email
address and date of death if applicable (maternal and child health will be excluded). The
research coordinator will email non-deceased patients 7-14 days after their admission date.
The email will be sent to patients with an email address in PennChart. The email will not
include any personally identifiable information regarding the patient or mention of their
recent admission/visit. The email will include high-level information regarding Our Care
Wishes, effectively summarizing the information that the patient received in their admission
folder and stating the value of ACP, along with a direct link to access Our Care Wishes.

For this process, it is estimated that the RR will spend 60-90 seconds noting the presence of
the handout in the admissions folder and sending the patient a direct link (for those that
opt-in). Frequency of the intervention will be every patient admitted via Silverstein 1
Admissions office and seen in Pre-Admission Testing during the intervention timeframe.

Each week, a report will be constructed via EPIC reporting to identify the patients that are
admitted via these offices during this timeframe. The report will be made available to only
key personnel on this research study. The report will also include this information which is
routinely collected during the course of a hospitalization:

- Demographics (date of birth, sex, etc.)

- Date of death (if recorded in the EHR)

- Place of death (if recorded in the EHR)

- Dates of hospitalization(s)

- Contact information (email address and mobile phone number)MRN

- HAR

- Name

- Unit admitted to

- Presence of AD in EHR

- Admission source (need ED and Silver 1)

- Outside hospital transfer? (exclude if yes)

- Mother/baby? (exclude if yes)

- PAT appointment date

Inclusion Criteria:

- Adult admitted at the University of Pennsylvania via two locations: the Emergency
Department, Silverstein 1 admission office;

- Patients that are seen in the Pre-Admission Testing (PAT) clinic

- Patients must speak English fluently

Exclusion Criteria:

- Maternity patients