Affiliation:
1. East Tennessee State University, Johnson City, TN, USA
Abstract
Advance care planning (ACP) is a conversation about values, future treatment choices, and designation of a surrogate decision-maker, held in advance of a health crisis. ACP protocols are established by home health agencies (HHAs) to support the staff in talking about patients’ future treatment choices, which can include opting against acute care use. In 2016, Medicare implemented an experimental incentive program called Home Health Value-Based Purchasing (HHVBP) in 9 regionally representative states. These agencies were required to compete on value, where reimbursement rates were tied to outcomes in a Total Performance Score (TPS). With home health’s aim of avoiding unplanned acute care use, in-patient hospitalization was weighted the heaviest as a poor outcome, followed by emergency department (ED) use. The purpose of this quasi-interventional study was to determine the relationship between advance care planning protocols and ED use among HHAs in the U. S. by the status of participation HHVBP intervention group. The Advance Care Planning Protocol (ACPP) score was measured by scoring survey questions. Our findings show (1) ACPP score intensity was higher in states that participated in the HHVBP program; (2) high measurement reliability for the ACPP scores; (3) no significant relationship between ACPP and ED use overall; but (4) the relationship between ACPP intensity and ED use was equal-and-opposite for the HHVBP and non-HHVBP groups. These findings suggest that the HHVBP intervention altered the influence of ACPP intensity on ED use. Recommendations are made for the HHVBP program regarding ACP’s role in goal-concordant care.
Subject
Public Health, Environmental and Occupational Health,Community and Home Care,Leadership and Management
Reference21 articles.
1. Defining Advance Care Planning for Adults: A Consensus Definition From a Multidisciplinary Delphi Panel
2. CMS (Centers for Medicare and Medicaid Services). Home Health Value Based Purchasing (HHVPB). (2016). Accessed January 20, 2021. https://innovation.cms.gov/initiatives/homehealth-value-based-purchasing-model
3. CMS (Centers for Medicare and Medicaid Services). (2015). Home health star ratings. Accessed January 20, 2021. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/
4. Critical Association Between Mental Health Disorders and Medical Status: Depression Intervention Use Indicates a Two-Fold Risk for Subsequent Medical Events in Older American Home Health Care Patients
5. Impact of Community Health Workers on Elderly Patients’ Advance Care Planning and Health Care Utilization