Abstract：
BACKGROUND: Advance care planning (ACP) is a process that helps people prepare to make decisions about their future medical care.
OBJECTIVE: We sought to understand who was received billed ACP visits and measure the association with health care utilization, cost, and mortality.
METHODS: We used a randomly sampled 20 % cohort of Medicare fee-for-service (FFS) beneficiaries\' files to conduct a retrospective cohort study. Beneficiaries with a billed ACP visit were matched to controls using a 2-stage propensity score matching process that included assigning a pseudo-ACP visit date for controls. Outcomes included healthcare utilization, mortality, and total medical cost per month. We used descriptive statistics for univariate analysis and fit multilevel logistic regression, multilevel linear regression, or Cox regression models.
RESULTS: We identified 183,513 beneficiaries who received any billed ACP visit and 550,539 matched controls. Of those who had a ACP visit, the mean age was 76.5 years and high-risk comorbidities were common: 16 % dementia, 10 % congestive heart failure, 10 % cancer. Beneficiaries who had an ACP visit had slightly more health care utilization than controls. Beneficiaries who had an ACP visit were more likely to die (3.1% vs. 1.0 %, p < 0.01, OR=3.0, 95 %CI 2.9-3.2) in the unadjusted and adjusted analyses compared to matched controls. Total monthly medical costs were 33 % higher among beneficiaries who had an ACP visit.
CONCLUSIONS: Our results suggest that ACP visits may be preferentially utilized amongst individuals with higher risk of mortality. There may be an opportunity to increase ACP visits among older adults at lower risk for mortality.
CONCLUSIONS: This article suggests that ACP visits are likely targeted to older adults with a higher risk of mortality than those at lower risk of mortality suggesting an opportunity to reach people before they are facing end-of-life decisions.
OBJECTIVE: We sought to understand who was received billed ACP visits and measure the association with health care utilization, cost, and mortality.
METHODS: We used a randomly sampled 20 % cohort of Medicare fee-for-service (FFS) beneficiaries\' files to conduct a retrospective cohort study. Beneficiaries with a billed ACP visit were matched to controls using a 2-stage propensity score matching process that included assigning a pseudo-ACP visit date for controls. Outcomes included healthcare utilization, mortality, and total medical cost per month. We used descriptive statistics for univariate analysis and fit multilevel logistic regression, multilevel linear regression, or Cox regression models.
RESULTS: We identified 183,513 beneficiaries who received any billed ACP visit and 550,539 matched controls. Of those who had a ACP visit, the mean age was 76.5 years and high-risk comorbidities were common: 16 % dementia, 10 % congestive heart failure, 10 % cancer. Beneficiaries who had an ACP visit had slightly more health care utilization than controls. Beneficiaries who had an ACP visit were more likely to die (3.1% vs. 1.0 %, p < 0.01, OR=3.0, 95 %CI 2.9-3.2) in the unadjusted and adjusted analyses compared to matched controls. Total monthly medical costs were 33 % higher among beneficiaries who had an ACP visit.
CONCLUSIONS: Our results suggest that ACP visits may be preferentially utilized amongst individuals with higher risk of mortality. There may be an opportunity to increase ACP visits among older adults at lower risk for mortality.
CONCLUSIONS: This article suggests that ACP visits are likely targeted to older adults with a higher risk of mortality than those at lower risk of mortality suggesting an opportunity to reach people before they are facing end-of-life decisions.
摘要：
背景：提前护理计划（ACP）是一个过程，可以帮助人们准备对未来的医疗服务做出决定。
目的：我们试图了解谁收到了ACP的账单，并衡量与医疗保健利用的关联，成本,和死亡率。
方法：我们使用随机抽样的20％的医疗保险收费服务（FFS）受益人队列进行回顾性队列研究。使用2阶段倾向评分匹配过程,包括为对照分配伪ACP访问日期,将具有已计费ACP访问的受益人与对照进行匹配。结果包括医疗保健利用，死亡率,每月的医疗费用。我们使用描述性统计进行单变量分析和拟合多水平逻辑回归，多级线性回归，或Cox回归模型。
结果：我们确定了183,513名接受任何计费ACP访问的受益人和550,539名匹配的对照。在那些访问过ACP的人中，平均年龄为76.5岁，高危合并症很常见：16％的痴呆症，10%充血性心力衰竭,10%的癌症。接受ACP访问的受益人的医疗保健利用率略高于对照组。接受ACP访问的受益人更有可能死亡（3.1%与1.0%，与匹配的对照组相比，未调整和调整的分析中p<0.01，OR=3.0，95CI2.9-3.2）。在接受ACP访问的受益人中，每月总医疗费用高出33%。
结论：我们的结果表明，ACP访视可能优先用于死亡率较高的个体。在死亡风险较低的老年人中，可能有机会增加ACP访视。
结论：本文表明，ACP访视的对象可能是死亡率较高的老年人，而不是死亡率较低的老年人，这表明他们有机会在面临临终决定之前接触到他们。
目的：我们试图了解谁收到了ACP的账单，并衡量与医疗保健利用的关联，成本,和死亡率。
方法：我们使用随机抽样的20％的医疗保险收费服务（FFS）受益人队列进行回顾性队列研究。使用2阶段倾向评分匹配过程,包括为对照分配伪ACP访问日期,将具有已计费ACP访问的受益人与对照进行匹配。结果包括医疗保健利用，死亡率,每月的医疗费用。我们使用描述性统计进行单变量分析和拟合多水平逻辑回归，多级线性回归，或Cox回归模型。
结果：我们确定了183,513名接受任何计费ACP访问的受益人和550,539名匹配的对照。在那些访问过ACP的人中，平均年龄为76.5岁，高危合并症很常见：16％的痴呆症，10%充血性心力衰竭,10%的癌症。接受ACP访问的受益人的医疗保健利用率略高于对照组。接受ACP访问的受益人更有可能死亡（3.1%与1.0%，与匹配的对照组相比，未调整和调整的分析中p<0.01，OR=3.0，95CI2.9-3.2）。在接受ACP访问的受益人中，每月总医疗费用高出33%。
结论：我们的结果表明，ACP访视可能优先用于死亡率较高的个体。在死亡风险较低的老年人中，可能有机会增加ACP访视。
结论：本文表明，ACP访视的对象可能是死亡率较高的老年人，而不是死亡率较低的老年人，这表明他们有机会在面临临终决定之前接触到他们。
