Skip to main content

The Association of Advance Care Planning Documentation and End-of-Life Healthcare Use Among Patients With Multimorbidity.

Publication ,  Journal Article
McDermott, CL; Engelberg, RA; Khandelwal, N; Steiner, JM; Feemster, LC; Sibley, J; Lober, WB; Curtis, JR
Published in: Am J Hosp Palliat Care
August 2021

PURPOSE: Multimorbidity is associated with increased intensity of end-of-life healthcare. This association has been examined by number but not type of conditions. Our purpose was to understand how intensity of care is influenced by multimorbidity within specific chronic conditions to provide guidance for interventions to improve end-of-life care for these patients. METHODS: We identified adults cared for in a multihospital healthcare system who died between 2010-2017. We categorized patients by 4 primary chronic conditions: heart failure, pulmonary disease, renal disease, or dementia. Within each condition, we examined the effect of multimorbidity (presence of 4 or more chronic conditions) on hospital and ICU admission in the last 30 days of life, in-hospital death, and advance care planning (ACP) documentation >30 days before death. We performed logistic regression to estimate associations between multimorbidity and end-of-life care utilization, stratified by the presence or absence of ACP documentation. RESULTS: ACP documentation >30 days before death was associated with lower odds of in-hospital death for all 4 conditions both in patients with and without multimorbidity. With the exception of patients with renal disease without multimorbidity, we observed lower odds of hospitalization and ICU admission for all patients with ACP >30 days before death. CONCLUSIONS: Patients with dementia and multimorbidity had the highest odds of high-intensity end-of-life care. For patients with dementia, heart failure, or pulmonary disease, ACP documentation >30 days before death was associated with lower likelihood of in-hospital death, hospitalization, and ICU use at end-of-life, regardless of multimorbidity.

Duke Scholars

Published In

Am J Hosp Palliat Care

DOI

EISSN

1938-2715

Publication Date

August 2021

Volume

38

Issue

8

Start / End Page

954 / 962

Location

United States

Related Subject Headings

  • Multimorbidity
  • Humans
  • Hospital Mortality
  • Gerontology
  • Documentation
  • Delivery of Health Care
  • Death
  • Advance Care Planning
  • Adult
  • 4205 Nursing
 

Citation

APA
Chicago
ICMJE
MLA
NLM
McDermott, C. L., Engelberg, R. A., Khandelwal, N., Steiner, J. M., Feemster, L. C., Sibley, J., … Curtis, J. R. (2021). The Association of Advance Care Planning Documentation and End-of-Life Healthcare Use Among Patients With Multimorbidity. Am J Hosp Palliat Care, 38(8), 954–962. https://doi.org/10.1177/1049909120968527
McDermott, Cara L., Ruth A. Engelberg, Nita Khandelwal, Jill M. Steiner, Laura C. Feemster, James Sibley, William B. Lober, and J Randall Curtis. “The Association of Advance Care Planning Documentation and End-of-Life Healthcare Use Among Patients With Multimorbidity.Am J Hosp Palliat Care 38, no. 8 (August 2021): 954–62. https://doi.org/10.1177/1049909120968527.
McDermott CL, Engelberg RA, Khandelwal N, Steiner JM, Feemster LC, Sibley J, et al. The Association of Advance Care Planning Documentation and End-of-Life Healthcare Use Among Patients With Multimorbidity. Am J Hosp Palliat Care. 2021 Aug;38(8):954–62.
McDermott, Cara L., et al. “The Association of Advance Care Planning Documentation and End-of-Life Healthcare Use Among Patients With Multimorbidity.Am J Hosp Palliat Care, vol. 38, no. 8, Aug. 2021, pp. 954–62. Pubmed, doi:10.1177/1049909120968527.
McDermott CL, Engelberg RA, Khandelwal N, Steiner JM, Feemster LC, Sibley J, Lober WB, Curtis JR. The Association of Advance Care Planning Documentation and End-of-Life Healthcare Use Among Patients With Multimorbidity. Am J Hosp Palliat Care. 2021 Aug;38(8):954–962.

Published In

Am J Hosp Palliat Care

DOI

EISSN

1938-2715

Publication Date

August 2021

Volume

38

Issue

8

Start / End Page

954 / 962

Location

United States

Related Subject Headings

  • Multimorbidity
  • Humans
  • Hospital Mortality
  • Gerontology
  • Documentation
  • Delivery of Health Care
  • Death
  • Advance Care Planning
  • Adult
  • 4205 Nursing