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End‐of‐Life Care Planning in Accountable Care Organizations: Associations with Organizational Characteristics and Capabilities
Author(s) -
Ahluwalia Sangeeta C.,
Harris Benjamin J.,
Lewis Valerie A.,
Colla Carrie H.
Publication year - 2018
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12720
Subject(s) - medicaid , advance care planning , health informatics , health care , palliative care , business , logistic regression , informatics , operations management , nursing , process management , medicine , public health , engineering , electrical engineering , economics , economic growth
Objective To measure the extent to which accountable care organizations ( ACO s) have adopted end‐of‐life ( EOL ) care planning processes and characterize those ACO s that have established processes related to EOL . Data Sources This study uses data from three waves (2012–2015) of the National Survey of ACO s. Respondents were 397 ACO s participating in Medicare, Medicaid, and commercial ACO contracts. Study Design This is a cross‐sectional survey study using multivariate ordered logit regression models. We measured the extent to which the ACO had adopted EOL care planning processes as well as organizational characteristics, including care management, utilization management, health informatics, and shared decision‐making capabilities, palliative care, and patient‐centered medical home experience. Principal Findings Twenty‐one percent of ACO s had few or no EOL care planning processes, 60 percent had some processes, and 19.6 percent had advanced processes. ACO s with a hospital in their system ( OR : 3.07; p = .01), and ACO s with advanced care management ( OR : 1.43; p = .02), utilization management ( OR : 1.58, p = .00), and shared decision‐making capabilities ( OR : 16.3, p = .000) were more likely to have EOL care planning processes than those with no hospital or few to no capabilities. Conclusions There remains considerable room for today's ACO s to increase uptake of EOL care planning, possibly by leveraging existing care management, utilization management, and shared decision‐making processes.