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Advance Care Planning Claims and Health Care Utilization Among Seriously Ill Patients Near the End of Life

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...

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Autores principales: Ashana, Deepshikha Charan, Chen, Xiaoxue, Agiro, Abiy, Sridhar, Gayathri, Nguyen, Ann, Barron, John, Haynes, Kevin, Fisch, Michael, Debono, David, Halpern, Scott D., Harhay, Michael O.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6827391/
https://www.ncbi.nlm.nih.gov/pubmed/31675087
http://dx.doi.org/10.1001/jamanetworkopen.2019.14471
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author Ashana, Deepshikha Charan
Chen, Xiaoxue
Agiro, Abiy
Sridhar, Gayathri
Nguyen, Ann
Barron, John
Haynes, Kevin
Fisch, Michael
Debono, David
Halpern, Scott D.
Harhay, Michael O.
author_facet Ashana, Deepshikha Charan
Chen, Xiaoxue
Agiro, Abiy
Sridhar, Gayathri
Nguyen, Ann
Barron, John
Haynes, Kevin
Fisch, Michael
Debono, David
Halpern, Scott D.
Harhay, Michael O.
author_sort Ashana, Deepshikha Charan
collection PubMed
description 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, AND PARTICIPANTS: This retrospective cohort study conducted from October 1, 2015, to May 31, 2018, used a national commercial insurance claims database to retrieve data from 18 484 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 AND MEASURES: 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 18 484 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.
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spelling pubmed-68273912019-11-18 Advance Care Planning Claims and Health Care Utilization Among Seriously Ill Patients Near the End of Life Ashana, Deepshikha Charan Chen, Xiaoxue Agiro, Abiy Sridhar, Gayathri Nguyen, Ann Barron, John Haynes, Kevin Fisch, Michael Debono, David Halpern, Scott D. Harhay, Michael O. JAMA Netw Open Original Investigation 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, AND PARTICIPANTS: This retrospective cohort study conducted from October 1, 2015, to May 31, 2018, used a national commercial insurance claims database to retrieve data from 18 484 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 AND MEASURES: 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 18 484 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. American Medical Association 2019-11-01 /pmc/articles/PMC6827391/ /pubmed/31675087 http://dx.doi.org/10.1001/jamanetworkopen.2019.14471 Text en Copyright 2019 Ashana DC et al. JAMA Network Open. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Ashana, Deepshikha Charan
Chen, Xiaoxue
Agiro, Abiy
Sridhar, Gayathri
Nguyen, Ann
Barron, John
Haynes, Kevin
Fisch, Michael
Debono, David
Halpern, Scott D.
Harhay, Michael O.
Advance Care Planning Claims and Health Care Utilization Among Seriously Ill Patients Near the End of Life
title Advance Care Planning Claims and Health Care Utilization Among Seriously Ill Patients Near the End of Life
title_full Advance Care Planning Claims and Health Care Utilization Among Seriously Ill Patients Near the End of Life
title_fullStr Advance Care Planning Claims and Health Care Utilization Among Seriously Ill Patients Near the End of Life
title_full_unstemmed Advance Care Planning Claims and Health Care Utilization Among Seriously Ill Patients Near the End of Life
title_short Advance Care Planning Claims and Health Care Utilization Among Seriously Ill Patients Near the End of Life
title_sort advance care planning claims and health care utilization among seriously ill patients near the end of life
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6827391/
https://www.ncbi.nlm.nih.gov/pubmed/31675087
http://dx.doi.org/10.1001/jamanetworkopen.2019.14471
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