Does ACP promote increased hospice utilization? A practice experience among three diverse OCM populations in Texas.

Abstract

6 Background: A community oncology practice participating in the Oncology Care Model (OCM) has interest in promoting hospice utilization through delivery of proactive advance care planning (ACP) services. This review of data seeks to understand geographic and ethnic variations in Medicare population utilization of ACP program services and timely transition to hospice care at the end of life. The study population included over 43% having stage IV disease at diagnosis; 19% had lung cancer. Methods: Three sites in Texas were selected for review. Site 1: central Texas urban community with primary non-Hispanic population. Site 2: south Texas urban community with primary Hispanic population. Site 3: central/east Texas rural community with primary non-Hispanic population. A 15-month retrospective review of ACP and hospice data was performed for deceased patients having OCM enrollment between January 1, 2017 and March 31, 2018. A total of 224 chart reviews were performed. Results: Little difference in hospice utilization is noted among the various populations, each demonstrating a hospice transition of care for more than 60% of OCM participants reviewed. All sites, however, showed median days in hospice care of five days or less. Formal ACP education was provided for 22% to 27% of urban study populations, while occurring for only 12% of patients seen in the rural setting. Written Advance Directives are captured in the electronic medical record more frequently for non-Hispanic patients when compared to those of Hispanic ethnicity. Formal values and goals for care were not routinely and formally assessed at these study sites, even though a validated tool for assisting with this important component of end-of-life preparedness is available. Conclusions: This study identified notable gaps in service provision to assist patients with end-of-life decision making. Increased efforts to provide ACP counseling services are needed to assist patients and families with ability to consider the additional level of care that is provided when electing hospice care. Overall, work is needed to improve hospice length of stay in all sites reviewed, but particularly among the Hispanic population of south Texas.