O-19 Beyond the basics: A comparison of cost and resource utilisation between basic and disease specific advance care planning

Abstract

Background Respecting Choices (RC) is an advance care planning (ACP) model developed in La Crosse, WI, USA. Basic ACP via this model was demonstrated in previous studies: LADS I (1998) and LADS II (2008). RC has since developed ACP for persons beginning to suffer effects from progressive, life-limiting illnesses, known as Next Steps (NS). Kirchhoff (2010 and 2012) demonstrated that NS improves patient and surrogate understanding of patients’ treatment preferences. Whether NS decreases healthcare utilisation or cost is currently unknown. Aim To detail the findings of an analysis of the value of NS ACP compared to basic ACP, including its impact on resource utilisation and patient medical costs. Methods A chart review of hospitalizations preceding death (≤2 years) to determine in-patient days, hospital utilisation, and Hospice utilisation of decedents with and without NS ACP from 1/1/2010 to 4/7/2014, matched on insurance, age, comorbidities, and marital status. Results 95% of variable group (n = 42) and ninety-three percent (n = 76) of control group had completed basic ACP at time of death. Those with NS ACP had fewer hospital encounters and greater Hospice utilisation compared with controls. Analysis of insurance costs shows that billed costs over the last two years of life decreased among the variable group but increased among the control group. Discussion We found that hospital encounters, intensity, and medical costs decrease with NS planning, while time in Hospice significantly increases. Conclusion Staged approaches to ACP are valuable. NS ACP can lower hospital utilisation and medical costs at the end of life for patients with life-limiting illnesses.