Advance Care Planning (ACP) in Medicare Beneficiaries with Heart Failure.
J Gen Intern Med
; 39(13): 2487-2495, 2024 Oct.
Article
em En
| MEDLINE
| ID: mdl-38769259
ABSTRACT
BACKGROUND:
Heart failure is a leading cause of death in the USA, contributing to high expenditures near the end of life. Evidence remains lacking on whether billed advance care planning changes patterns of end-of-life healthcare utilization among patients with heart failure. Large-scale claims evaluation assessing billed advance care planning and end-of-life hospitalizations among patients with heart failure can fill evidence gaps to inform health policy and clinical practice.OBJECTIVE:
Assess the association between billed advance care planning delivered and Medicare beneficiaries with heart failure upon the type and quantity of healthcare utilization in the last 30 days of life.DESIGN:
This retrospective cross-sectional cohort study used Medicare fee-for-service claims from 2016 to 2020.PARTICIPANTS:
A total of 48,466 deceased patients diagnosed with heart failure on Medicare. MAINMEASURES:
Billed advance care planning services between the last 12 months and last 30 days of life will serve as the exposure. The outcomes are end-of-life healthcare utilization and total expenditure in inpatient, outpatient, hospice, skilled nursing facility, and home healthcare services. KEYRESULTS:
In the final cohort of 48,466 patients (median [IQR] age, 83 [76-89] years; 24,838 [51.2%] women; median [IQR] Charlson Comorbidity Index score, 4 [2-5]), 4406 patients had an advance care planning encounter. Total end-of-life expenditure among patients with billed advance care planning encounters was 19% lower (95% CI, 0.77-0.84) compared to patients without. Patients with billed advance care planning encounters had 2.65 times higher odds (95% CI, 2.47-2.83) of end-of-life outpatient utilization with a 33% higher expected total outpatient expenditure (95% CI, 1.24-1.42) compared with patients without a billed advance care planning encounter.CONCLUSIONS:
Billed advance care planning delivery to individuals with heart failure occurs infrequently. Prioritizing billed advance care planning delivery to these individuals may reduce total end-of-life expenditures and end-of-life inpatient expenditures through promoting use of outpatient end-of-life services, including home healthcare and hospice.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Assistência Terminal
/
Medicare
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Planejamento Antecipado de Cuidados
/
Insuficiência Cardíaca
Limite:
Aged
/
Aged80
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Female
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Humans
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Male
País como assunto:
America do norte
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article