Article Text
PDF
Abstract
Objective To investigate associations between the availability and timing of digitally available advance care planning (ACP) documents and hospital use and costs during the last 6 months of life.
Design Retrospective population-based cohort study using data linkage.
Setting 11 public hospitals in Queensland, Australia.
Participants 5586 decedents with ACP documents were directly matched 1:2 to 11 172 control decedents based on age category, sex, location, year of death and principal diagnosis code for the last-known hospital admission.
Exposure ACP discussions with documents uploaded to a widely accessible statewide digital platform. Directly matched subgroup analyses investigated differences between decedents with ACP documents available at three different times prior to death: ≥6 months, between 1 and 6 months, and <1 month.
Main outcomes and measures Emergency department (ED) presentations, hospital and intensive care unit (ICU) admissions, and in-hospital deaths, expressed as adjusted OR (aOR). Secondary outcomes were hospital bed-days and costs.
Results ACP decedents with documents uploaded ≥6 months prior to death, compared with controls, had fewer ED presentations (aOR 0.90, 95% CI 0.81 to 1.00), hospitalisations (aOR 0.83, 95% CI 0.74 to 0.92), ICU admissions (aOR 0.23, 95% CI 0.10 to 0.48), and in-hospital deaths (aOR 0.56, 95% CI 0.51 to 0.63), and lower adjusted mean hospital costs per person over the last 6 months of life ($A2290 less (95% CI −$4116 to −$463)). Conversely, decedents with ACP documents uploaded less than 6 months prior to death showed higher rates of ED presentations and hospital admissions and greater hospital costs relative to controls.
Conclusion The association between digitally available ACP documents and health service use and cost differed based on the timing of ACP upload, with documents available ≥6 months prior to death being associated with less hospital use and costs.
- Decision Making
- EPIDEMIOLOGIC STUDIES
- GENERAL MEDICINE (see Internal Medicine)
- Health economics
- Observational Study
- Patient-Centered Care
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information. Our ethical approvals prevent individual-level data from being shared beyond those named on the ethics application (Authors Reymond, Sansome, Carter). Aggregate-level data may be shared where appropriate. Author Hannah Carter can be contacted if there are any queries related to data or analysis (Hannah.carter@qut.edu.au).
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Statistics from Altmetric.com
- Decision Making
- EPIDEMIOLOGIC STUDIES
- GENERAL MEDICINE (see Internal Medicine)
- Health economics
- Observational Study
- Patient-Centered Care
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information. Our ethical approvals prevent individual-level data from being shared beyond those named on the ethics application (Authors Reymond, Sansome, Carter). Aggregate-level data may be shared where appropriate. Author Hannah Carter can be contacted if there are any queries related to data or analysis (Hannah.carter@qut.edu.au).
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
X @Hannah_E_Carter
Contributors Concept and design: IS, LR, XS and HC. Acquisition, analysis or interpretation of data: LR, IS, XS and HC. Drafting of the manuscript: IS and HC. Critical revision of the manuscript for important intellectual content: LR, IS, XS and HC. Statistical analysis: HC and XS. Administrative, technical or material support: LR and IS. Supervision: IS and LR. HC is guarantor for this article, had access to all data and approved decision to publish.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.