Impact of Community Health Workers on Elderly Patients’ Advance Care Planning and Health Care Utilization: Moving the Dial

Debra Litzelman, Thomas Inui, Wilma J. Griffin, Anthony Perkins, Ann H. Cottingham, Kathleen M. Schmitt-Wendholt, Steven S. Ivy

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

BACKGROUND:: Advance care planning (ACP) is recommended for all persons to ensure that the care they receive aligns with their values and preferences. OBJECTIVE:: To evaluate an ACP intervention developed to better meet the needs and priorities of persons with chronic diseases, including mild cognitive impairment. RESEARCH DESIGN:: A year-long, pre-post intervention using lay community health workers [care coordinator assistants (CCAs)] trained to conduct and document ACP conversations with patients during home health visits with pre-post evaluation. SUBJECTS:: The 818 patients were 74.2 years old (mean); 78% women; 51% African American; 43% white. MEASURES:: Documentation of ACP conversation in electronic health record fields and health care utilization outcomes. RESULTS:: In this target population ACP documentation rose from 3.4% (pre-CCA training) to 47.9% (post) of patients who had at least 1 discussion about ACP in the electronic health record. In the 1-year preintervention period, there were no differences in admissions, emergency department (ED) visits, and outpatient visits between patients who did and did not have ACP discussion. After adjusting for prior hospitalization and ED use histories, ACP discussions were associated with a 34% less probability of hospitalization (hazard ratios, 0.66; 95% confidence interval, 0.45–0.97), and similar effects are apparent on ED use independent of age and prior ED use effects. CONCLUSIONS:: Patients with chronic diseases including mild cognitive impairment can engage in ACP conversations with trusted home health care providers. Having ACP conversation is associated with significant reduction in seeking urgent health care and in hospitalizations.

Original languageEnglish (US)
JournalMedical Care
DOIs
StateAccepted/In press - Nov 21 2016

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Advance Care Planning
Patient Acceptance of Health Care
Patient Care Planning
Hospital Emergency Service
Hospitalization
Electronic Health Records
Documentation
Chronic Disease
Community Health Services
House Calls
Health Services Needs and Demand
Home Care Services
Ambulatory Care
African Americans
Health Personnel
Outpatients

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Impact of Community Health Workers on Elderly Patients’ Advance Care Planning and Health Care Utilization : Moving the Dial. / Litzelman, Debra; Inui, Thomas; Griffin, Wilma J.; Perkins, Anthony; Cottingham, Ann H.; Schmitt-Wendholt, Kathleen M.; Ivy, Steven S.

In: Medical Care, 21.11.2016.

Research output: Contribution to journalArticle

Litzelman, Debra ; Inui, Thomas ; Griffin, Wilma J. ; Perkins, Anthony ; Cottingham, Ann H. ; Schmitt-Wendholt, Kathleen M. ; Ivy, Steven S. / Impact of Community Health Workers on Elderly Patients’ Advance Care Planning and Health Care Utilization : Moving the Dial. In: Medical Care. 2016.
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