Advance care planning among Medicare beneficiaries with dementia undergoing surgery.
Advance care planning among Medicare beneficiaries with dementia undergoing surgery.
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DOI：
10.1111/jgs.17226
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发表时间：
2021-08
影响因子：
6.3
通讯作者：
Weissman JS
中科院分区：
文献类型：
--
作者：
Shah SK;Manful A;Reich AJ;Semco RS;Tjia J;Ladin K;Weissman JS
高级护理计划(ACP)是指患者或他们的代理人与医生、律师、朋友和家人讨论护理的目标和偏好，是帮助将目标与实际治疗保持一致的重要方法。对于患有阿尔茨海默病和相关痴呆症(ADRD)等晚期严重疾病的患者来说，ACP可能特别有价值，对这些患者来说，手术有很大的风险。目的：确定接受非创伤性住院手术的ADRD患者的医疗保险受益人的ACP账单的频率、时间和相关因素。这项全国队列研究分析了2016-2017年的医疗保险收费服务索赔数据。所有患者都有6个月的回顾和随访期。国家医疗保险服务收费数据根据慢性病仓库定义，所有患有ADRD的患者在2016年7月1日至2017年6月30日期间接受住院手术。患者人口统计、病史和手术结果ACP帐单代码从入院前六个月到住院手术后六个月这项研究包括299957名接受手术的ADRD患者。21754例(7.5%)患者在手术前后6个月内发生过ACP。在多变量分析中，白人、男性和居住在美国南部和中西部的患者没有接受ACP的风险最高。在所有接受ACP的患者中，5960名(27.4%)在手术前接受了ACP，而12658名(52.8%)在手术后接受了ACP。术后ACP的时机与Elixhauser共病指数为3或更高(1.23，p=0.045)和主要术后并发症或死亡(OR1.52，p<；0.0001)相关。总体而言，在接受手术的ADRD患者中，ACP账单代码的使用率较低。开单的ACP似乎有一种反应模式，最常发生在手术后，并与术后死亡率和并发症有关。有必要进行额外的研究，以了解使用障碍。
Advance care planning (ACP), in which patients or their surrogates discuss goals and preferences for care with physicians, attorneys, friends and family, is an important approach to help align goals with actual treatment. ACP may be particularly valuable in patients with advanced serious illnesses such as Alzheimer’s Disease and related dementias (ADRD) for whom surgery carries significant risks. To determine the frequency, timing, and factors associated with ACP billing in Medicare beneficiaries with ADRD undergoing non-trauma inpatient surgery. This national cohort study analyses Medicare fee-for-service claims data from 2016-2017. All patients had a six-month lookback and follow-up period. National Medicare fee-for-service data All patients with ADRD, defined according to the Chronic Conditions Warehouse, undergoing inpatient surgery from July 1, 2016 to June 30, 2017. Patient demographics, medical history, and procedural outcomes ACP billing codes from six months before to six months after admission for inpatient surgery This study included 299,957 patients with ADRD undergoing surgery. 21,754 (7.5%) had billed ACP within the 6-months before and after surgical admission. In a multivariable analysis, patients of white race, male sex, and residence in the Southern and Midwestern US were at the highest risk of not receiving ACP. Of all patients who received ACP, 5,960 (27.4%) did so before surgery while 12,658 (52.8%) received ACP after surgery. Timing of ACP after surgery was associated with an Elixhauser comorbidity index of three or higher (1.23, p=0.045) and major postoperative complication or death (OR 1.52, p<0.0001). Overall ACP billing code use is low among Medicare patients with ADRD undergoing surgery. Billed ACP appears to have a reactive pattern, occurring most commonly after surgery and in association with postoperative mortality and complications. Additional study is warranted to understand barriers to use.
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影响因子：
6.3
作者：
Gupta A;Jin G;Reich A;Prigerson HG;Ladin K;Kim D;Ashana DC;Cooper Z;Halpern SD;Weissman JS
通讯作者：
Weissman JS
影响因子：
4.3
作者：
Shah, Samir K.;Jin, Ginger;Reich, Amanda J.;Gupta, Avni;Belkin, Michael;Weissman, Joel S.
通讯作者：
Weissman, Joel S.
DOI：
10.3122/jabfm.2019.06.190121
发表时间：
2019-11-01
影响因子：
2.9
作者：
Kim, Peter;Daly, Jeanette M.;Levy, Barcey T.
通讯作者：
Levy, Barcey T.
影响因子：
16.9
作者：
Sheetz, Kyle H.;Dimick, Justin B.;Ghaferi, Amir A.
通讯作者：
Ghaferi, Amir A.
影响因子：
120.7
作者：
Dimick, Justin B.;Nicholas, Lauren H.;Ryan, Andrew M.;Thumma, Jyothi R.;Birkmeyer, John D.
通讯作者：
Birkmeyer, John D.