The affordable care act and do-not-resuscitate orders: Differences by race and ethnicity

BACKGROUND: The Affordable Care Act (ACA) created new payment rules that provided reimbursement for physicians to engage in advance care planning (ACP) conversations with patients. This reimbursement policy has the potential to increase ACP participation, including among racial and ethnic minority groups that have had lower ACP participation. OBJECTIVES: To examine whether the ACP payment rules were associated with an increase in use of do-not-resuscitate (DNR) orders, particularly among racial and ethnic minority groups, among patients diagnosed with heart failure (HF) in California. METHODS: The California Office of Statewide Health Planning and Development (OSHPD) Patient Discharge Data Set was used to identify a cohort of elderly patients with a principal diagnosis of HF. This study included 432,520 hospital admissions of patients over the age of 65 with a primary diagnosis of HF between 2012 and 2018. DNR status was identified using International Classification of Diseases, Clinical Modification Ninth and Tenth Revision, codes. RESULTS: There was a small increase in the utilization of DNR orders overall after the ACA reimbursement policy, but the change was not significantly different for all racial and ethnic groups when compared to white non-Hispanic patients. CONCLUSIONS: ACP payment rules provided in the ACA were associated with increased utilization of DNR, but the effect was not significantly different for racial and ethnic minorities hospitalized with HF in CA. Additional efforts are needed to increase ACP participation among racial and ethnic minorities.

© This manuscript version is made available under the CC-BY-NC-ND 4.0 license https://creativecommons.org/licenses/by-nc-nd/4.0/

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Work Title The affordable care act and do-not-resuscitate orders: Differences by race and ethnicity
Access
Open Access
Creators
  1. Katherine Callahan
  2. Yubraj Acharya
  3. Christopher S. Hollenbeak
Keyword
  1. End-of-life
  2. Heart failure
  3. DNR orders
  4. Affordable Care Act
License CC BY-NC-ND 4.0 (Attribution-NonCommercial-NoDerivatives)
Work Type Article
Publisher
  1. Heart and Lung
Publication Date January 18, 2023
Publisher Identifier (DOI)
  1. https://doi.org/10.1016/j.hrtlng.2023.01.009
Deposited August 05, 2023

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Version 1
published

  • Created
  • Added ACA_and_dnr_accepted_manuscript.pdf
  • Added Creator Katherine Callahan
  • Added Creator Yubraj Acharya
  • Added Creator Christopher S. Hollenbeak
  • Published
  • Updated Keyword, Publisher, Publication Date Show Changes
    Keyword
    • End-of-life, Heart failure, DNR orders, Affordable Care Act
    Publisher
    • Heart and Lung: Journal of Acute and Critical Care
    • Heart and Lung
    Publication Date
    • 2023-05-01
    • 2023-01-18
  • Updated