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A Quality Improvement Initiative for Inpatient Advance Care Planning
Olivia A Sacks1,2,3, Megan Murphy3, James O'Malley3,4
1Department of Surgery, Boston Medical Center, Boston, Massachusetts.
JAMA Health Forum
|October 4, 2024
Summary
A quality improvement initiative successfully increased advance care planning (ACP) billing rates in hospitals. However, the impact on patient treatment plans and outcomes was inconsistent, warranting further investigation into care quality measures.
Area of Science:
- Health Services Research
- Quality Improvement Science
- Geriatric Medicine
Background:
- The Centers for Medicare & Medicaid Services (CMS) introduced advance care planning (ACP) billing codes in 2016 and included ACP in quality metrics.
- Inpatient ACP billing rates have not been previously studied.
Purpose of the Study:
- To evaluate the effectiveness of an inpatient ACP quality improvement intervention.
- To assess the intervention's impact on ACP billing rates, hospital treatment plans, and patient outcomes.
Main Methods:
- Nationwide cohort study using difference-in-differences analysis.
- Compared Medicare beneficiaries (≥65 years) receiving care from intervention vs. non-intervention practitioners.
- Linked claims data (2015-2019) to assess ACP billing, inpatient treatments, and outcomes.
Main Results:
- ACP billing rates significantly increased in the intervention group (1.3% to 14.0%) compared to control groups (OR, 2.6).
- Increased ACP billing was associated with a significant decrease in inpatient deaths in the intervention group (OR, 0.95).
- Other associations between ACP billing and clinical outcomes were not significant.
Conclusions:
- The ACP quality initiative effectively increased ACP billing in inpatient settings.
- Observed changes in clinical outcomes were inconsistent with initial hypotheses.
- Further research is needed to explore confounding factors and unobserved measures of care quality.
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