Impact of Advance Care Planning on the Hospitalization-Associated Utilization and Cost of Patients with Alzheimer's Disease-Related Disorders Receiving Primary Care via Telehealth in a Provider Shortage Area: A Quantitative Pre-Study

• Published in: International journal of environmental research and public health 2023-06, Vol.20 (12), p.6157
• Main Authors: Yoo, Ji Won, Reed, Peter S, Shen, Jay J, Carson, Jennifer, Kang, Mingon, Reeves, Jerry, Kim, Yonsu, Choe, Ian, Kim, Pearl, Kim, Laurie, Kang, Hee-Taik, Tabrizi, Maryam
• Format: Article
• Language: English
• Subjects: Advance directives; Aging; Alzheimer's disease; Ambulatory care; Caregivers; Coronaviruses; Cost estimates; COVID-19; Dementia; Documentation; Electronic health records; Electronic medical records; Geriatrics; Health care; Health care access; Hospitalization; Hospitals; Medicare; Pandemics; Patients; Primary care; Public health; Standard deviation; Telemedicine; Transportation services; Trends
• ISSN: 1660-4601; 1661-7827; 1660-4601
• DOI: 10.3390/ijerph20126157

Telehealth has been adopted as an alternative to in-person primary care visits. With multiple participants able to join remotely, telehealth can facilitate the discussion and documentation of advance care planning (ACP) for those with Alzheimer's disease-related disorders (ADRDs). We measured hospitalization-associated utilization outcomes, instances of hospitalization and 90-day re-hospitalizations from payors' administrative databases and verified the data via electronic health records. We estimated the hospitalization-associated costs using the Nevada State Inpatient Dataset and compared the estimated costs between ADRD patients with and without ACP documentation in the year 2021. Compared to the ADRD patients without ACP documentation, those with ACP documentation were less likely to be hospitalized (mean: 0.74; standard deviation: 0.31; < 0.01) and were less likely to be readmitted within 90 days of discharge (mean: 0.16; standard deviation: 0.06; < 0.01). The hospitalization-associated cost estimate for ADRD patients with ACP documentation (mean: USD 149,722; standard deviation: USD 80,850) was less than that of the patients without ACP documentation (mean: USD 200,148; standard deviation: USD 82,061; < 0.01). Further geriatrics workforce training is called for to enhance ACP competencies for ADRD patients, especially in areas with provider shortages where telehealth plays a comparatively more important role.