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Emergency Department Use and Advance Care Planning in Home Health Value-Based Purchasing.
- Source :
- Home Health Care Management & Practice; Nov2022, Vol. 34 Issue 4, p280-287, 8p
- Publication Year :
- 2022
-
Abstract
- Advance care planning (ACP) is a conversation about values, future treatment choices, and designation of a surrogate decision-maker, held in advance of a health crisis. ACP protocols are established by home health agencies (HHAs) to support the staff in talking about patients' future treatment choices, which can include opting against acute care use. In 2016, Medicare implemented an experimental incentive program called Home Health Value-Based Purchasing (HHVBP) in 9 regionally representative states. These agencies were required to compete on value, where reimbursement rates were tied to outcomes in a Total Performance Score (TPS). With home health's aim of avoiding unplanned acute care use, in-patient hospitalization was weighted the heaviest as a poor outcome, followed by emergency department (ED) use. The purpose of this quasi-interventional study was to determine the relationship between advance care planning protocols and ED use among HHAs in the U. S. by the status of participation HHVBP intervention group. The Advance Care Planning Protocol (ACPP) score was measured by scoring survey questions. Our findings show (1) ACPP score intensity was higher in states that participated in the HHVBP program; (2) high measurement reliability for the ACPP scores; (3) no significant relationship between ACPP and ED use overall; but (4) the relationship between ACPP intensity and ED use was equal-and-opposite for the HHVBP and non-HHVBP groups. These findings suggest that the HHVBP intervention altered the influence of ACPP intensity on ED use. Recommendations are made for the HHVBP program regarding ACP's role in goal-concordant care. [ABSTRACT FROM AUTHOR]
- Subjects :
- EVALUATION of medical care
KRUSKAL-Wallis Test
STATISTICS
HOSPITAL emergency services
RESEARCH evaluation
CLINICAL trials
HOME care services
RESEARCH methodology
HEALTH outcome assessment
ADVANCE directives (Medical care)
MEDICAL protocols
MEDICAL care use
VALUE-based healthcare
HEALTH insurance reimbursement
T-test (Statistics)
QUESTIONNAIRES
CHI-squared test
DESCRIPTIVE statistics
DATA analysis
Subjects
Details
- Language :
- English
- ISSN :
- 10848223
- Volume :
- 34
- Issue :
- 4
- Database :
- Complementary Index
- Journal :
- Home Health Care Management & Practice
- Publication Type :
- Academic Journal
- Accession number :
- 159358640
- Full Text :
- https://doi.org/10.1177/10848223221082660