Callahan Katherine, Acharya Yubraj, Hollenbeak Christopher S
Department of Health Policy and Administration, College of Health and Human Development, The Pennsylvania State University, University Park, PA 16802 USA.
Department of Health Policy and Administration, College of Health and Human Development, The Pennsylvania State University, University Park, PA 16802 USA.
Heart Lung. 2023 May-Jun;59:16-22. doi: 10.1016/j.hrtlng.2023.01.009. Epub 2023 Jan 18.
The Affordable Care Act (ACA) created new payment rules that provided reimbursement for physicians to engage in advance care planning (ACP) conversations with patients. This reimbursement policy has the potential to increase ACP participation, including among racial and ethnic minority groups that have had lower ACP participation.
To examine whether the ACP payment rules were associated with an increase in use of do-not-resuscitate (DNR) orders, particularly among racial and ethnic minority groups, among patients diagnosed with heart failure (HF) in California.
The California Office of Statewide Health Planning and Development (OSHPD) Patient Discharge Data Set was used to identify a cohort of elderly patients with a principal diagnosis of HF. This study included 432,520 hospital admissions of patients over the age of 65 with a primary diagnosis of HF between 2012 and 2018. DNR status was identified using International Classification of Diseases, Clinical Modification Ninth and Tenth Revision, codes.
There was a small increase in the utilization of DNR orders overall after the ACA reimbursement policy, but the change was not significantly different for all racial and ethnic groups when compared to white non-Hispanic patients.
ACP payment rules provided in the ACA were associated with increased utilization of DNR, but the effect was not significantly different for racial and ethnic minorities hospitalized with HF in CA. Additional efforts are needed to increase ACP participation among racial and ethnic minorities.
《平价医疗法案》（ACA）制定了新的支付规则，为医生与患者进行提前护理规划（ACP）对话提供报销。这项报销政策有可能增加ACP的参与度，包括在参与度较低的种族和族裔少数群体中。
研究在加利福尼亚州，ACP支付规则是否与不进行心肺复苏（DNR）医嘱的使用增加相关，特别是在种族和族裔少数群体的心力衰竭（HF）患者中。
使用加利福尼亚州全州卫生规划与发展办公室（OSHPD）的患者出院数据集来确定一组主要诊断为HF的老年患者。本研究纳入了2012年至2018年间432,520例年龄在65岁以上、主要诊断为HF的患者住院病例。使用国际疾病分类第九版和第十版临床修订本代码确定DNR状态。
ACA报销政策实施后，DNR医嘱的总体使用率略有上升，但与非西班牙裔白人患者相比，所有种族和族裔群体的变化没有显著差异。
ACA中提供的ACP支付规则与DNR使用率增加相关，但对于加利福尼亚州因HF住院的种族和族裔少数群体，其效果没有显著差异。需要做出更多努力来提高种族和族裔少数群体对ACP的参与度。
