Examining the Association of Billed Advance Care Planning With End-of-Life Hospital Admissions Among Advanced Cancer Patients in Hospice

Author:

Prater Laura C.12ORCID,O’Rourke Brian3,Schnell Patrick4,Xu Wendy3,Li Yiting3,Gustin Jillian5,Lockwood Bethany5,Lustberg Maryam67,White Susan7,Happ Mary Beth8,Retchin Sheldon M.23,Wickizer Thomas M.3,Bose-Brill Seuli2

Affiliation:

1. Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA

2. Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA

3. Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus, OH, USA

4. Division of Biostatistics, The Ohio State University College of Public Health, Columbus, OH, USA

5. Division of Palliative Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA

6. Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus OH, USA

7. James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA

8. The Ohio State University College of Nursing, Columbus, OH, USA

Abstract

Background: Advance care planning (ACP), or the consideration and communication of care preferences for the end-of-life (EOL), is a critical process for improving quality of care for patients with advanced cancer. The incorporation of billed service codes for ACP allows for new inquiries on the association between systematic ACP and improved EOL outcomes. Objective: Using the IBM MarketScan® Database, we conducted a retrospective medical claims analysis for patients with an advanced cancer diagnosis and referral to hospice between January 2016 and December 2017. We evaluated the association between billed ACP services and EOL hospital admissions in the final 30 days of life. Design: This is a cross-sectional retrospective cohort study. Participants: A total of 3,705 patients met the study criteria. Main Measures: ACP was measured via the presence of a billed ACP encounter (codes 99497 and 99498) prior to the last 30 days of life; hospital admissions included a dichotomous indicator for inpatient admission in the final 30 days of life. Key Results: Controlling for key covariates, patients who received billed ACP were less likely to experience inpatient hospital admissions in the final 30 days of life compared to those not receiving billed ACP (OR: 0.34; p < 0.001). Conclusion: The receipt of a billed ACP encounter is associated with reduced EOL hospital admissions in a population of patients with advanced cancer on hospice care. Strategies for consistent, anticipatory delivery of billable ACP services prior to hospice referral may prevent potentially undesired late-life hospital admissions.

Funder

Pelotonia Postdoctoral Fellowship

Publisher

SAGE Publications

Subject

General Medicine

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