Abstract
Background
Advance care planning (ACP) benefits emergency department (ED) patients with advanced
illness. Although Medicare implemented physician reimbursement for ACP discussions
in 2016, early studies found limited uptake.
Objective
We conducted a pilot study to assess ACP documentation and billing to inform the development
of ED-based interventions to increase ACP. Methods: We conducted a retrospective chart
review to quantify the proportion of ED patients with advanced illness with Physician
Orders for Life-Sustaining Treatment (POLST) or coding of ACP discussion in the medical
record. We surveyed a subset of patients via phone to evaluate ACP participation.
Results: Of 186 patients included in the chart review, 68 (37%) had a POLST and none
had ACP discussions billed. Of 50 patients surveyed, 18 (36%) recalled prior ACP discussions.
Conclusions: Given the low uptake of ACP discussions in ED patients with advanced
illness, the ED may be an underused setting for interventions to increase ACP discussions
and documentation.
Keywords
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Article info
Publication history
Published online: December 16, 2022
Accepted:
December 13,
2022
Received in revised form:
August 13,
2022
Received:
May 12,
2022
Publication stage
In Press Uncorrected ProofIdentification
Copyright
© 2022 Published by Elsevier Inc.
