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- Title
Advance Care Planning in an Accountable Care Organization Is Associated with Increased Advanced Directive Documentation and Decreased Costs.
- Authors
Bond, William F.; Kim, Minchul; Franciskovich, Chris M.; Weinberg, Jason E.; Svendsen, Jessica D.; Fehr, Linda S.; Funk, Amy; Sawicki, Robert; Asche, Carl V.
- Abstract
<bold><italic>Background:</italic></bold> Advance care planning (ACP) documents patient wishes and increases awareness of palliative care options. <bold><italic>Objective:</italic></bold> To study the association of outpatient ACP with advanced directive documentation, utilization, and costs of care. <bold><italic>Design:</italic></bold> This was a case–control study of cases with ACP who died matched 1:1 with controls. We used 12 months of data pre-ACP/prematch and predeath. We compared rates of documentation with logit model regression and conducted a difference-in-difference analysis using generalized linear models for utilization and costs. <bold><italic>Setting/subjects:</italic></bold> Medicare beneficiaries attributed to a large rural-suburban-small metro multisite accountable care organization from January 2013 to April 2016, with cross reference to ACP facilitator logs to find cases. <bold><italic>Measurements:</italic></bold> The presence of advance directive forms was verified by chart review. Cost analysis included all utilization and costs billed to Medicare. <bold><italic>Results:</italic></bold> We matched 325 cases and 325 controls (51.1% female and 48.9% male, mean age 81). 320/325 (98.5%) ACP versus 243/325 (74.8%) of controls had a Healthcare Power of Attorney (odds ratio [OR] 21.6, 95% CI 8.6–54.1) and 172/325(52.9%) ACP versus 145/325 (44.6%) controls had Practitioner Orders for Life Sustaining Treatment (OR 1.40, 95% CI 1.02–1.90) post-ACP/postmatch. Adjusted results showed ACP cases had fewer inpatient admissions (−0.37 admissions, 95% CI −0.66 to −0.08), and inpatient days (−3.66 days, 95% CI −6.23 to −1.09), with no differences in hospice, hospice days, skilled nursing facility use, home health use, 30-day readmissions, or emergency department visits. Adjusted costs were $9,500 lower in the ACP group (95% CI −$16,207 to −$2,793). <bold><italic>Conclusions:</italic></bold> ACP increases documentation and was associated with a reduction in overall costs driven primarily by a reduction in inpatient utilization. Our data set was limited by small numbers of minorities and cancer patients.
- Subjects
DOCUMENTATION; TIME; ADVANCE directives (Medical care); CASE-control method; ACCOUNTABLE care organizations
- Publication
Journal of Palliative Medicine, 2018, Vol 21, Issue 4, p489
- ISSN
1096-6218
- Publication type
Article
- DOI
10.1089/jpm.2017.0566