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

Ji Won Yoo (), Peter S. Reed, Jay J. Shen, Jennifer Carson, Mingon Kang, Jerry Reeves, Yonsu Kim, Ian Choe, Pearl Kim, Laurie Kim, Hee-Taik Kang and Maryam Tabrizi
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Ji Won Yoo: Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV 89154, USA
Peter S. Reed: Sanford Center for Aging, Reno School of Medicine, University of Nevada, Reno, NV 89557, USA
Jay J. Shen: School of Public Health, University of Nevada, Las Vegas, NV 89119, USA
Jennifer Carson: Sanford Center for Aging, Reno School of Medicine, University of Nevada, Reno, NV 89557, USA
Mingon Kang: Department of Computer Science, Howard Hughes College of Engineering, University of Nevada, Las Vegas, NV 89154, USA
Jerry Reeves: Comagine Health, Las Vegas, NV 89118, USA
Yonsu Kim: School of Public Health, University of Nevada, Las Vegas, NV 89119, USA
Ian Choe: Telehealth Divison, Optum Care Network of Nevada, Las Vegas, NV 89128, USA
Pearl Kim: School of Public Health, University of Nevada, Las Vegas, NV 89119, USA
Laurie Kim: Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV 89154, USA
Hee-Taik Kang: Department of Family Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
Maryam Tabrizi: Department of Clinical Sciences, School of Dental Medicine, University of Nevada, Las Vegas, NV 89154, USA

IJERPH, 2023, vol. 20, issue 12, 1-11

Abstract: 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; p < 0.01) and were less likely to be readmitted within 90 days of discharge (mean: 0.16; standard deviation: 0.06; p < 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; p < 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.

Keywords: advance care plan; age-friendly health system; dementia; finances; primary care; telehealth (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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