Using routinely collected data to ascertain concordance with advance care planning preferences
File(s)
Accepted version
Author(s)
Tan, Woan Shin
Bajpai, Ram
Low, Chan Kee
Ho, Andy Hau Yan
Car, Josip
Type
Journal Article
Abstract
BACKGROUND: One of the key outcomes of Advance Care Planning (ACP) is whether patients had received care that was consistent with their expressed goals and preferences. AIM: To illustrate the feasibility of using routinely collected healthcare data that includes hospital procedural codes, diagnosis-related codes, health services utilisation and death registry data, to ascertain the level of concordance between care received and the stated goals. DESIGN: In this retrospective cohort study, medical treatments were ascertained using a combination of hospital procedural codes, and diagnosis-related codes. Places of care were obtained by reviewing the sequence of health services utilised, and the place of death was obtained from the national death registry. To ascertain concordance, medical treatment, places of care, and place of death, were compared against the individual's preferences. RESULTS: The sample include 1,731 decedents (aged 21 years and above) who completed their ACP documentation as part of a national programme. Ninety-eight percent who wished for comfort measures met their preferences. Sixty-five percent of individuals who wished to be cared for at home received care at home. Nearly 40% of all individuals who opted to die at home achieved their wishes; whereas 76% of those who opted for home or hospital and home or hospice had their preferences fulfilled. CONCLUSION: Administrative data offer a cost-efficient and powerful method for assessing outcomes for a large population-based national programme. However, this approach is still at an early stage of development, and needs to be further validated before it can be used at scale.
Date Issued
2018-11-01
Date Acceptance
2018-07-24
Citation
Journal of Pain and Symptom Management, 2018, 56 (5), pp.659-666.e2
ISSN
0885-3924
Publisher
Elsevier
Start Page
659
End Page
666.e2
Journal / Book Title
Journal of Pain and Symptom Management
Volume
56
Issue
5
Copyright Statement
© 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence http://creativecommons.org/licenses/by-nc-nd/4.0/
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/30096442
PII: S0885-3924(18)30391-9
Subjects
advance care planning
concordance
place of care
place of death
preferences
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2018-08-07