Trends in the use of advance care planning and cognitive assessment and care planning service visits: moving toward a palliative-informed approach for ambulatory care of community-dwelling persons with dementia and their caregivers.

INTRODUCTION

Both the advance care planning (ACP) visit and cognitive assessment and care planning service (CAACPS) visit offer palliative-oriented care for persons with Alzheimer's disease and related dementias (ADRD); however, the rate of ACP visits remains low, and little has been reported regarding CAACPS visits. Furthermore, few reports describe use of either visit among Medicare Advantage (MA) beneficiaries. This study describes provision of ACP and CAACPS visits to community-dwelling older adult MA beneficiaries with ADRD.

METHODS

Using deidentified Optum Clinformatics Data Mart claims data, we evaluated ambulatory care visits for community-dwelling older adult MA beneficiaries with ADRD for the years 2018 to 2019.

RESULTS

For 2018 and 2019, 3.5% and 5.4% received ACP visits, and 0.4% and 0.5% received CAACPS visits, similar to use reported elsewhere.

DISCUSSION

Few MA beneficiaries with ADRD received ACP or CAACPS visits, and the delivery of CAACPs visits is similar to that reported for non-MA beneficiaries.

HIGHLIGHTS

Most persons with dementia are community-dwelling and disproportionately disadvantaged. Access to palliative care is limited for community-dwelling persons with dementia. CAACPS visits may address this gap. Our findings show the use of CAACPS visits is very low.