Advance Care Planning Claims and Health Care Utilization Among Seriously Ill Patients Near the End of Life.
JAMA Netw Open
; 2(11): e1914471, 2019 11 01.
Article
in En
| MEDLINE
| ID: mdl-31675087
ABSTRACT
Importance Although advance care planning is known to increase patient and caregiver satisfaction, its association with health care utilization is not well understood. Objective:
To examine the association between billed advance care planning encounters and subsequent health care utilization among seriously ill patients. Design, Setting, andParticipants:
This retrospective cohort study conducted from October 1, 2015, to May 31, 2018, used a national commercial insurance claims database to retrieve data from 18â¯484 Medicare Advantage members 65 years or older who had a claim that contained a serious illness diagnosis. Exposure A claim that contained an advance care planning billing code between October 1, 2016, and November 30, 2017. Main Outcomes andMeasures:
Receipt of intensive therapies, hospitalization, emergency department use, hospice use, costs, and death during the 6-month follow-up period.Results:
The final study sample included 18â¯484 seriously ill patients (mean [SD] age, 79.7 [7.9] years; 10 033 [54.3%] female), 864 (4.7%) of whom had a billed advanced care planning encounter between October 1, 2016, and November 30, 2017. In analyses adjusted for patient characteristics and a propensity score for advance care planning, the presence of a billed advance care planning encounter was associated with a higher likelihood of hospice enrollment (incidence rate ratio [IRR], 2.52; 95% CI, 2.22-2.86) and mortality (hazard ratio, 2.27; 95% CI, 1.79-2.88) compared with no billed advance care planning encounter. Although patients with billed advance care planning encounters were also more likely to be hospitalized (IRR, 1.37; 95% CI, 1.26-1.49), including in the intensive care unit (IRR, 1.25; 95% CI, 1.08-1.45), they were less likely to receive any intensive therapies (IRR, 0.85; 95% CI, 0.78-0.92), such as chemotherapy (IRR, 0.65; 95% CI, 0.55-0.78). Similar results were observed in a propensity score-matched analysis (99% matched) and in a decedent analysis of patients who died during the 6-month follow-up period. Conclusions and Relevance Patients with billed advance care planning encounters were more likely than those without these encounters to receive hospice services and less likely to receive any intensive therapies, such as chemotherapy. However, they were also hospitalized more frequently than patients without billed advance care planning encounters. Although these findings were robust to multiple analytic methods, the results may be attributable to residual confounding because of a higher unmeasured severity of illness in the advance care planning group. Additional evidence appears to be needed to understand the effect of advance care planning on these outcomes.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Hospice Care
/
Critical Illness
/
Advance Care Planning
/
Hospitalization
Type of study:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Risk_factors_studies
Aspects:
Implementation_research
Limits:
Aged
/
Aged80
/
Female
/
Humans
/
Male
Country/Region as subject:
America do norte
Language:
En
Journal:
JAMA Netw Open
Year:
2019
Document type:
Article