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

Publication ,  Journal Article
Ashana, DC; Chen, X; Agiro, A; Sridhar, G; Nguyen, A; Barron, J; Haynes, K; Fisch, M; Debono, D; Halpern, SD; Harhay, MO
Published in: JAMA Netw Open
November 1, 2019

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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Published In

JAMA Netw Open

DOI

EISSN

2574-3805

Publication Date

November 1, 2019

Volume

2

Issue

11

Start / End Page

e1914471

Location

United States

Related Subject Headings

  • United States
  • Retrospective Studies
  • Medicare Part C
  • Male
  • Humans
  • Hospitalization
  • Hospice Care
  • Health Care Costs
  • Female
  • Databases, Factual
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Ashana, D. C., Chen, X., Agiro, A., Sridhar, G., Nguyen, A., Barron, J., … Harhay, M. O. (2019). Advance Care Planning Claims and Health Care Utilization Among Seriously Ill Patients Near the End of Life. JAMA Netw Open, 2(11), e1914471. https://doi.org/10.1001/jamanetworkopen.2019.14471
Ashana, Deepshikha Charan, Xiaoxue Chen, Abiy Agiro, Gayathri Sridhar, Ann Nguyen, John Barron, Kevin Haynes, et al. “Advance Care Planning Claims and Health Care Utilization Among Seriously Ill Patients Near the End of Life.JAMA Netw Open 2, no. 11 (November 1, 2019): e1914471. https://doi.org/10.1001/jamanetworkopen.2019.14471.
Ashana DC, Chen X, Agiro A, Sridhar G, Nguyen A, Barron J, et al. Advance Care Planning Claims and Health Care Utilization Among Seriously Ill Patients Near the End of Life. JAMA Netw Open. 2019 Nov 1;2(11):e1914471.
Ashana, Deepshikha Charan, et al. “Advance Care Planning Claims and Health Care Utilization Among Seriously Ill Patients Near the End of Life.JAMA Netw Open, vol. 2, no. 11, Nov. 2019, p. e1914471. Pubmed, doi:10.1001/jamanetworkopen.2019.14471.
Ashana DC, Chen X, Agiro A, Sridhar G, Nguyen A, Barron J, Haynes K, Fisch M, Debono D, Halpern SD, Harhay MO. Advance Care Planning Claims and Health Care Utilization Among Seriously Ill Patients Near the End of Life. JAMA Netw Open. 2019 Nov 1;2(11):e1914471.

Published In

JAMA Netw Open

DOI

EISSN

2574-3805

Publication Date

November 1, 2019

Volume

2

Issue

11

Start / End Page

e1914471

Location

United States

Related Subject Headings

  • United States
  • Retrospective Studies
  • Medicare Part C
  • Male
  • Humans
  • Hospitalization
  • Hospice Care
  • Health Care Costs
  • Female
  • Databases, Factual