Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, 2050 Kenny Road, Columbus, OH, 43215, USA.
Center for Health Outcomes in Medicine Scholarship and Service, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.
J Gen Intern Med. 2024 Oct;39(13):2487-2495. doi: 10.1007/s11606-024-08604-1. Epub 2024 May 20.
Heart failure is a leading cause of death in the USA, contributing to high expenditures near the end of life. Evidence remains lacking on whether billed advance care planning changes patterns of end-of-life healthcare utilization among patients with heart failure. Large-scale claims evaluation assessing billed advance care planning and end-of-life hospitalizations among patients with heart failure can fill evidence gaps to inform health policy and clinical practice.
Assess the association between billed advance care planning delivered and Medicare beneficiaries with heart failure upon the type and quantity of healthcare utilization in the last 30 days of life.
This retrospective cross-sectional cohort study used Medicare fee-for-service claims from 2016 to 2020.
A total of 48,466 deceased patients diagnosed with heart failure on Medicare.
Billed advance care planning services between the last 12 months and last 30 days of life will serve as the exposure. The outcomes are end-of-life healthcare utilization and total expenditure in inpatient, outpatient, hospice, skilled nursing facility, and home healthcare services.
In the final cohort of 48,466 patients (median [IQR] age, 83 [76-89] years; 24,838 [51.2%] women; median [IQR] Charlson Comorbidity Index score, 4 [2-5]), 4406 patients had an advance care planning encounter. Total end-of-life expenditure among patients with billed advance care planning encounters was 19% lower (95% CI, 0.77-0.84) compared to patients without. Patients with billed advance care planning encounters had 2.65 times higher odds (95% CI, 2.47-2.83) of end-of-life outpatient utilization with a 33% higher expected total outpatient expenditure (95% CI, 1.24-1.42) compared with patients without a billed advance care planning encounter.
Billed advance care planning delivery to individuals with heart failure occurs infrequently. Prioritizing billed advance care planning delivery to these individuals may reduce total end-of-life expenditures and end-of-life inpatient expenditures through promoting use of outpatient end-of-life services, including home healthcare and hospice.
心力衰竭是美国的主要死亡原因之一，导致临终前的支出居高不下。在心力衰竭患者中，有证据表明开具预先护理计划账单是否改变了临终医疗保健的利用模式。评估心力衰竭患者开具预先护理计划账单和临终住院情况的大规模索赔评估可以填补证据空白，为卫生政策和临床实践提供信息。
评估在生命最后 30 天内开具预先护理计划账单与医疗保险受益人心力衰竭患者的类型和数量之间的关联。
这是一项使用 2016 年至 2020 年医疗保险费用服务索赔的回顾性横断面队列研究。
共纳入 48466 名在医疗保险中诊断为心力衰竭且已去世的患者。
在生命的最后 12 个月至最后 30 天内开具预先护理计划服务将作为暴露因素。结局是临终医疗保健的利用和住院、门诊、临终关怀、熟练护理设施和家庭保健服务的总支出。
在最终的 48466 名患者队列中（中位数[IQR]年龄，83[76-89]岁；24838[51.2%]为女性；中位数[IQR]Charlson 合并症指数评分，4[2-5]），4406 名患者有预先护理计划就诊。与没有预先护理计划就诊的患者相比，有预先护理计划就诊记录的患者的总临终支出降低了 19%（95%CI，0.77-0.84）。有预先护理计划就诊记录的患者在生命最后阶段接受门诊服务的可能性高 2.65 倍（95%CI，2.47-2.83），预计门诊总支出增加 33%（95%CI，1.24-1.42）。
向心力衰竭患者开具预先护理计划的情况很少见。优先向这些患者开具预先护理计划可能会通过促进使用临终门诊服务（包括家庭保健和临终关怀）来降低总临终支出和临终住院支出。
