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Advance Care Planning Among Patients With Advanced Illness Presenting to the Emergency Department

Joshua N Asiaban¹, Sohil Patel¹, Cora H Ormseth¹

¹School of Medicine, University of California San Francisco, San Francisco, California.

The Journal of Emergency Medicine

|March 29, 2023

Abstract

Background:

Advance care planning (ACP) benefits emergency department (ED) patients with advanced illness. Although Medicare implemented physician reimbursement for ACP discussions in 2016, early studies found limited uptake.

Objective:

We conducted a pilot study to assess ACP documentation and billing to inform the development of ED-based interventions to increase ACP.

Methods:

We conducted a retrospective chart review to quantify the proportion of ED patients with advanced illness with Physician Orders for Life-Sustaining Treatment (POLST) or coding of ACP discussion in the medical record. We surveyed a subset of patients via phone to evaluate ACP participation.

Results:

Of 186 patients included in the chart review, 68 (37%) had a POLST and none had ACP discussions billed. Of 50 patients surveyed, 18 (36%) recalled prior ACP discussions.

Conclusions:

Given the low uptake of ACP discussions in ED patients with advanced illness, the ED may be an underused setting for interventions to increase ACP discussions and documentation.

Keywords:

Advance care planning Advance directive Advanced illness Emergency department POLST Reimbursement

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