• Seuli Bose Brill, Sean R Riley, Laura Prater, Patrick M Schnell, SchusterAnne L RALRDepartment of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA., Sakima A Smith, Beth Foreman, Wendy Yi Xu, Jillian Gustin, Yiting Li, Chen Zhao, Todd Barrett, and J Madison Hyer.
• Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, 2050 Kenny Road, Columbus, OH, 43215, USA. Seuli.Brill@osumc.edu.
• J Gen Intern Med. 2024 Oct 1; 39 (13): 248724952487-2495.

BackgroundHeart failure is a leading cause of death in the USA, contributing to high expenditures near the end of life. Evidence remains lacking on whether billed advance care planning changes patterns of end-of-life healthcare utilization among patients with heart failure. Large-scale claims evaluation assessing billed advance care planning and end-of-life hospitalizations among patients with heart failure can fill evidence gaps to inform health policy and clinical practice.ObjectiveAssess the association between billed advance care planning delivered and Medicare beneficiaries with heart failure upon the type and quantity of healthcare utilization in the last 30 days of life.DesignThis retrospective cross-sectional cohort study used Medicare fee-for-service claims from 2016 to 2020.ParticipantsA total of 48,466 deceased patients diagnosed with heart failure on Medicare.Main MeasuresBilled advance care planning services between the last 12 months and last 30 days of life will serve as the exposure. The outcomes are end-of-life healthcare utilization and total expenditure in inpatient, outpatient, hospice, skilled nursing facility, and home healthcare services.Key ResultsIn the final cohort of 48,466 patients (median [IQR] age, 83 [76-89] years; 24,838 [51.2%] women; median [IQR] Charlson Comorbidity Index score, 4 [2-5]), 4406 patients had an advance care planning encounter. Total end-of-life expenditure among patients with billed advance care planning encounters was 19% lower (95% CI, 0.77-0.84) compared to patients without. Patients with billed advance care planning encounters had 2.65 times higher odds (95% CI, 2.47-2.83) of end-of-life outpatient utilization with a 33% higher expected total outpatient expenditure (95% CI, 1.24-1.42) compared with patients without a billed advance care planning encounter.ConclusionsBilled advance care planning delivery to individuals with heart failure occurs infrequently. Prioritizing billed advance care planning delivery to these individuals may reduce total end-of-life expenditures and end-of-life inpatient expenditures through promoting use of outpatient end-of-life services, including home healthcare and hospice.© 2024. The Author(s).

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