Background Advance Care Planning (ACP) is an important conversation that patients have with their care team to understand their medical condition and establish goals of care. Few studies, however, have investigated its impact on hospital resources. This study aims to determine the association between ACP and its effect on healthcare utilisation and cost.
Methods 1343 patients from a tertiary hospital in Singapore completed either a General ACP or ACP – Preferred Plan of Care (PPC) from January 2013 to December 2017. Healthcare utilisation data was studied for each group pre- and post-6 months from ACP completion date. This included number of admissions, length of inpatient hospitalisation stay, attendance to the emergency department and specialist outpatient clinics. Total inpatient bill size was used as a marker of healthcare cost. Univariate analysis with paired T-tests was used to explore any significant difference in hospital utilisation rates between pre- and post-ACP in each group.
Results 366 patients and 977 patients completed General ACP and ACP-PPC respectively. For ACP-PPC group, there was significant reduction in healthcare utilisation and cost (%delta: 36–76%, P<0.05). Whereas for General ACP group, the length of stay and inpatient bill size were significantly decreased.
Conclusion ACP forms an integral component in patient care, especially for patients with more advanced diseases. Other than allowing patients to understand personhood and their goals of care, it serves as a platform to moderate healthcare utilisation. This study shows that ACP may reduce healthcare utilisation and cost.
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