Systemwide Advance Care Planning During the Covid-19 Pandemic: The Impact on Patient Outcomes and Cost

Abstract

Summary WellSpan Health, an integrated system of eight hospitals and more than 170 outpatient locations, adopted a systemwide approach to implement team-based advance care planning (ACP) processes and during the pandemic created a remote response team to help high-risk patients with Covid-19 with ACP. The authors analyzed ICU use and costs for 356 patients who died of Covid-19 after being admitted to WellSpan hospitals. They compared patients who had completed ACP prior to hospitalization (53%) with those who had not (47%). While the patients who completed the ACP process were older than those who did not (79 vs. 73 years) and had greater acuity (LACE + score 71 vs. 65; LACE is a mnemonic representing a composite score, where L stands for length of stay, A for acuity, C for comorbidities and E for emergency department visits within last 6 months), they were less likely to use the ICU (62% vs. 78%) and accrued 25% lower costs whether they received ICU care or not. Systematic ACP, leading to proactive decision-making for treatment preferences by patients and their family members, can reduce unwanted medical interventions and the cost of care.