Outpatient Advance Care Planning (ACP) in an Accountable Care Organization: Impact on Documentation, Utilization, and Costs (FR420B)

Abstract

•Describe a case-control study design, including cost analysis methods, for Advance Care Planning research.•Share the associations found between Advance Care Planning, documentation completion and healthcare utilization and costs. Advance Care Planning (ACP) increases the chances that patients’ wishes will be known and followed. Previous studies of ACP’s effects have typically focused on specific diseases, inpatient settings, and short intervals prior to death. To study the association of ACP with documentation, utilization, and costs of care within a cohort of Medicare beneficiaries in an Accountable Care Organization (ACO). This was a case control study of patients who died with ACP compared to matched controls without ACP from January 2013 to April 2016. Matching 1:1 was conducted via an algorithm that included demographic and utilization factors. We required 12 months data pre-ACP/pre-match and 12 months data pre-death. Data included inpatient, outpatient, and multi-system utilization and costs for ACO assigned patients. All charts were reviewed to verify Health Care Power of Attorney (HCPOA), and Practitioner Orders for Life Sustaining Treatment (POLST) documents. We used a logit model to compare documentation, and generalized linear models for utilization and cost analysis with difference-in-difference method. We matched 325 cases and 325 controls (51.1% female, 48.9% male, mean age 81). 320/325 ACP vs. 243/325 had HCPOA (p<0.05), and 172/325 ACP vs. 145/325 had POLST post-ACP/post-match (p<0.05)). Adjusted results showed ACP cases had fewer inpatient admissions (-0.37 admissions, 95% CI -0.66, -0.08), and fewer inpatient days (-3.66 days, 95% CI -6.23 to -1.09), with no differences in hospice use, hospice length of stay (LOS), skilled nursing facility use, home health use, 30-day readmissions, or emergency department visits. Costs were $9,500 lower in the ACP group (95% CI -$16,207, -$2,793). ACP increases formal documentation, which along with the ACP discussion record, make wishes more clearly known. ACP was associated with a reduction in overall costs, driven by less inpatient utilization.