Cardiac and Pulmonary Diagnoses and Advance Care Planning in Home Health

Abstract

Chronic cardiovascular and pulmonary diseases are prevalent in the US home health population. Heart failure and chronic obstructive pulmonary disease are both chronic and terminal, but they are not always perceived as serious illnesses with imminent death. Therefore, they provide a context for advance care planning that is distinct from the diagnostic contexts of cancer, end-stage renal disease, or dementia. Advance care planning is defined as a process that supports adults at any age or stage of health in understanding and sharing their goals, values, and preferences about future medical care, including the designation of a surrogate decision-maker. This study tests the hypothesis that US home health agencies with higher percentages of patients with chronic cardiovascular and pulmonary conditions have less robust advance care planning protocols. The Spearman correlation coefficient was r = 0.22 ( S = 74684, P = .025, 1-tailed), which was statistically significant and an unexpected finding. The greater percentage of patients with chronic cardiac and pulmonary diagnoses in an agency, the more robust the advance care planning protocol was. This supports our previous findings and existing literature indicating that agencies may be using exacerbation events marked by acute care use as opportunities to initiate or repeat advance care planning.

Emergency Department Use and Advance Care Planning in Home Health Value-Based Purchasing

“…These current findings are also congruent with our previous finding of 2022 that HHAs with more robust ACP protocols tend to have high percentages of patients with cardiac and pulmonary diagnoses, whose conditions are punctuated by exacerbation events, suggesting that these patients do prefer to use acute care services. 18 Meanwhile, HHAs may refer patients with other serious illnesses to other services in line with their goals and treatment preferences that do not include acute care services. 17 Together, the 3 studies suggested that HHVBP agencies with robust ACP protocols were associated with higher hospitalization rates, higher ED use rates, and higher proportions of patients with cardiac and pulmonary diagnoses.…”