A Vibe Check on Patients Seen for Advance Care Planning by a Growing Palliative Care Team from 2017 to 2021

Outcomes 1. Utilizing a discussion of the study's objectives, methodology, and Results: , participants will self-report the characteristics of patients seen by a palliative care team for advance care planning over five years in various clinical settings. 2. Utilizing a discussion of the study's pertinent findings, participants will identify potential differences in providing and receiving advance care planning among clinicians and patients. Key Message Along with expansion of our PC team over five years came an uptrend in completed ACP encounters. Despite practicing in an area with a large minority population, most patients seen were white and non-Hispanic. A mere third of the patients resided in areas of healthcare underutilization. Introduction Advance care planning (ACP) is central to high-quality end-of-life care since it allows patients to maintain an active role in their treatment. Previous studies have linked ACP with increased patient and family satisfaction with care, and less aggressive medical management near death. In 2015, the Center for Medicare and Medicaid Services introduced two Current Procedural Technology (CPT) codes allowing clinicians to bill for ACP based on time spent. Objectives To describe the characteristics of patients seen for ACP by palliative care clinicians from January 1, 2017 to December 31, 2021. Methods This was a retrospective cross-sectional study of patients seen by our growing team of palliative care clinicians within a large hospital system. All ACP encounters completed in various clinical settings (hospitals, outpatient clinics, nursing facilities and homes) and billed using the CPT codes "99497" and "99498" were included. Results We examined 12,575 encounters with 10,307 unique patients. The number of billed ACP encounters increased across the study period. Majority of patients were female (52%), white (74%), and non-Hispanic (96%). Roughly a third (32%) of patients lived in community outreach zones—zip code clusters of healthcare underutilization. Most patients were seen in the hospital setting (74%) and on regular nursing floors (75%). Most encounters (63%) were billed for 30 minutes. Conclusion Along with expansion of our PC team over five years came an uptrend in completed ACP encounters. Despite practicing in an area with a large minority population, most patients seen were white and non-Hispanic. A mere third of the patients resided in areas of healthcare underutilization. These findings hint at potential differences in providing and receiving ACP. Future efforts could look at factors affecting ACP that involve clinicians, patients and communities. Keywords Shared Decision Making / Advance Care PlanningDiversity, Equity, Inclusion, Belonging, Justice