Association of Billed Advance Care Planning with End-of-Life Care Intensity for 2017 Medicare Decedents.
Association of Billed Advance Care Planning with End-of-Life Care Intensity for 2017 Medicare Decedents.
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DOI：
10.1111/jgs.16683
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发表时间：
2020-09
影响因子：
6.3
通讯作者：
Weissman JS
中科院分区：
文献类型：
--
作者：
Gupta A;Jin G;Reich A;Prigerson HG;Ladin K;Kim D;Ashana DC;Cooper Z;Halpern SD;Weissman JS
医疗保险和医疗补助服务中心（CMS）报销临床医生与医疗保险患者进行的预先护理计划（ACP）讨论。本研究的目的是检查CMS计费的ACP访视与生命末期（EOL）医疗保健利用的相关性。2017年随机20%医疗保险服务费（FFS）死者样本的索赔患者水平分析。为了解释多重比较，Bonferroni调整的P值<.008被认为是统计学显著的。Medicare FFS受益人的全国代表性样本。共有237，989名Medicare FFS受益人在2017年死亡，包括那些在2016-17年期间有和没有账单ACP访问的人。关键暴露变量是首次收到ACP账单（无，死亡前>1个月）。EOL医疗保健利用率或强度的6项指标（住院、急诊科[艾德]访视、重症监护室[ICU]停留时间和死亡后30天内的支出、院内死亡和死亡后3天内的首次临终关怀）。分析调整了年龄、种族、性别、Charlson Comorbid指数、达特茅斯医院转诊地区的费用（高、中、低）和双重资格。总体而言，6.3%（14，986）的样本至少进行了一次收费ACP访视。多变量调整后，ACP访视患者在6项指标中的4项上经历的强化EOL护理显著减少：住院（比值比[OR] = .77; 95%置信区间[CI] = .74-.79），艾德访视（OR = 0.77; 95%CI = 0.75 - 0.80）或在死亡后一个月内入住ICU（OR = 0.78; 95%CI = 0.74 - 0.81）;并且他们在医院死亡的可能性较小（OR = 0.79; 95%CI = 0.76 - 0.82）。晚期临终关怀登记率（OR = 0.97; 95%CI = 0.92 -1.01; P = 0.119）或平均支出（242.50美元; 95%CI =-103.63美元至588.61美元; P = 0.169）没有差异。在Medicare FFS死亡者中，计费ACP访视相对不常见，但其发生与不太密集的EOL利用相关。进一步研究的变量影响临终关怀的使用和支出在EOL期间，建议了解ACP的相对作用。
The Centers for Medicare & Medicaid Services (CMS) reimburses clinicians for advance care planning (ACP) discussions with Medicare patients. The objective of the study was to examine the association of CMS-billed ACP visits with end-of-life (EOL) healthcare utilization. Patient-level analyses of claims for the random 20% Medicare fee-for-service (FFS) sample of decedents in 2017. To account for multiple comparisons, Bonferroni adjusted P value <.008 was considered statistically significant. Nationally representative sample of Medicare FFS beneficiaries. A total of 237,989 Medicare FFS beneficiaries who died in 2017 and included those with and without a billed ACP visit during 2016–17. The key exposure variable was receipt of first billed ACP (none, >1 month before death). Six measures of EOL healthcare utilization or intensity (inpatient admission, emergency department [ED] visit, intensive care unit [ICU] stay, and expenditures within 30 days of death, in-hospital death, and first hospice within 3 days of death). Analyses was adjusted for age, race, sex, Charlson Comorbidity Index, expenditure by Dartmouth hospital referral region (high, medium, or low), and dual eligibility. Overall, 6.3% (14,986) of the sample had at least one billed ACP visit. After multivariable adjustment, patients with an ACP visit experienced significantly less intensive EOL care on four of six measures: hospitalization (odds ratio [OR] = .77; 95% confidence interval [CI] = .74–.79), ED visit (OR = .77; 95% CI = .75–.80), or ICU stay (OR = .78; 95% CI = .74–.81) within a month of death; and they were less likely to die in the hospital (OR = .79; 95% CI = .76–.82). There were no differences in the rate of late hospice enrollment (OR = .97; 95% CI = .92–1.01; P = .119) or mean expenditures ($242.50; 95% CI = −$103.63 to $588.61; P = .169). Billed ACP visits were relatively uncommon among Medicare FFS decedents, but their occurrence was associated with less intensive EOL utilization. Further research on the variables affecting hospice use and expenditures in the EOL period is recommended to understand the relative role of ACP.
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DOI：
10.1001/jama.2018.8981
发表时间：
2018-07-17
期刊：
JAMA
影响因子：
--
作者：
Teno JM;Gozalo P;Trivedi AN;Bunker J;Lima J;Ogarek J;Mor V
通讯作者：
Mor V
影响因子：
6.3
作者：
Bischoff KE;Sudore R;Miao Y;Boscardin WJ;Smith AK
通讯作者：
Smith AK
影响因子：
3.7
作者：
Luta X;Maessen M;Egger M;Stuck AE;Goodman D;Clough-Gorr KM
通讯作者：
Clough-Gorr KM
影响因子：
39.2
作者：
SCHNEIDERMAN, LJ;KRONICK, R;LANGER, RD
通讯作者：
LANGER, RD
DOI：
10.1111/j.1532-5415.2007.01045.x
发表时间：
2007-02-01
影响因子：
6.3
作者：
Teno, Joan M.;Gruneir, Andrea;Wetle, Terrie
通讯作者：
Wetle, Terrie