The Center for Improving Value in Health Care (CIVHC) is proud to announce the publication of its first internally led research project in the American Journal of Hospice and Palliative Medicine. Titled “Disparities in End-of-Life Care: A Retrospective Study on Intensive Care Utilization and Advance Care Planning in the Colorado All Payer Claims Database,” the study examines how race, ethnicity, sex, and geographic location affect access to and quality of end-of-life (EOL) care for Coloradans.
End of Life Care and Advance Care Planning
Most people prefer to die at home as opposed to in a hospital, where EOL care is often emotionally and financially burdensome to patients and families. Intensive services at end-of-life disproportionally impact racial and ethnic minorities, rural residents, and lower socioeconomic seniors. Advance Care Planning (ACP) reduces the likelihood of unwanted medical interventions. It increases the use of hospice services, yet few studies have evaluated whether racial and ethnic disparities exist surrounding ACP and utilization of intensive EOL medical care.
Previous research has primarily focused on Medicare Fee-for-Service covered lives; this unique study, using claims from Colorado’s All Payer Claims Database (CO APCD), included nearly 93,000 people across commercial, Medicaid, and Medicare FFS and Advantage plans from 2018 to 2021. Comprehensive demographic and utilization data in the CO APCD enabled CIVHC researchers to examine how race, ethnicity, and geography affected ICU stays, ED visits, and ACP adoption, providing one of the few large-scale, multi-payer analyses to explore these inequities at the end of life.
Notable Trends
CIVHC’s study indicated significant disparities in the use of ICU stays, emergency department visits, and 30-day hospital readmissions. Notably, Hispanic, Asian, and Black people were more likely to experience intensive care at the end of life, and American Indian and Alaska Natives were less likely to have ACP compared to White people, even when controlling for comorbidities.