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Use of Advance Care Video Decision Aids Has Multiple Outcomes

06/01/2016

The Journal of General Internal Medicine published an article that explores the use of video decision aides in promoting advance care planning. Lead by Angelo E. Volandes, MD, MPH, Massachusetts General Hospital, the research study is set in Hilo, Hawaii, which has one hospital and one hospice. The study’s authors say, “Although ACP has been promoted as a promising avenue to improve the delivery of care at the end of life, scalable and cost-effective methods have not previously been examined.”

Simply put, the researchers utilized “a single, 1- to 4-h training and access to the ACP video decision aids. The training focused on the use of video decision aids in supporting – not replacing—ACP conversations.” Before the intervention, ACP documentation rate for inpatients with late-stage diseases was 3/2%. The number of ACP documentations, after the intervention, moved from 3.2% to 39.9%. Overall, after the intervention, Hilo had a 37% completion of ACP for these patients, compared with 25.6% elsewhere in the state.

There was more good news. Hospital rates declined in patients over 65. Prior to 2012, 5.1% was the in-hospital death rate for these patients. After the intervention, however, that number dropped to 4/3%. And, says the study, “Primary care providers in the intervention had an ACP completion rate for patients over 75 years of 37.0 % (1,437/3,888) compared to control providers, who had an average of 25.6 % (10,760/42,099) (P?
Improvement was also reported in terms of hospice utilization. Before the intervention, the hospital-to-hospice discharge rate was 5.7% for “patients with late-state disease.” After the intervention, the discharge to hospice rate rose to 13.8%. Hospice of Hilo reported growth in admission rates at a rate higher than state and national averages.

Costs of care were also improved. “The average total insurance cost for the last month of life among Hilo patients was $3,458 (95 % CI $3,051 to 3,865) lower per patient after the intervention when compared to the control region.”

The study demonstrates, it says, “that the success of the intervention shows how clinicians and patients can be empowered to engage in ACP and potentially reduce undesired treatment in our healthcare system.”

Overall, the one-time intervention is associated with an improvement in hospice utilization, increase in completed advance directives, and a decrease in costs of care during the last month of life. The complete report is available online.

Source: (Journal of General Internal Medicine, 5/16, http://download.springer.com/static/pdf/905/art%253A10.1007%252Fs11606-016-3730-2.pdf?originUrl=http%3A%2F%2Flink.springer.com%2Farticle%2F10.1007%2Fs11606-016-3730-2&token2=exp=1464467701~acl=%2Fstatic%2Fpdf%2F905%2Fart%25253A10.1007%25252Fs11606-016-3730-2.pdf%3ForiginUrl%3Dhttp%253A%252F%252Flink.springer.com%252Farticle%252F10.1007%252Fs11606-016-3730-2*~hmac=c41c5e674361b111443b1871d56fccb6ff0b907796c93084645f1bb20ccf89e7)