Abstract
Research has shown that Advance Care Planning (ACP) is associated with higher quality of life among patients nearing the end of life. However, studies exploring the impact of comprehensive ACP on health care utilization are limited, particularly among older adults. This retrospective study used Electronic Health Record (EHR) data to assess the association of documented ACP in the EHR and admissions during the last 30 days of life among a population of decedents (n=811) aged 65 and older who were referred to hospice between January 1, 2014 and December 31, 2015. Patients who had ACP documented in the problem list at least six months prior to death had a significantly reduced odds of admission in the last 30 days of life (OR=0.44; p=0.049). Similarly, the presence of a verified Do Not Resuscitate (DNR) order at least 30 days prior to death was significantly associated with a reduced odds of admission in the last 30 days of life (OR=0.25; p<0.001). The association between having an ACP note in the problem list or a verified DNR and a reduced odds of admission in the last 30 days of life among hospice patients demonstrates that EHR-documented, retrievable ACP has a significant impact on outcomes for older adults who are nearing the end of life. Programs and policies aimed toward enhancing communication and documentation of end-of-life preferences may lead to fewer unnecessary hospital admissions for older adults who have elected to receive hospice care.