Pub. 3 2019 Issue 2

of remaining life. Very few Americans have taken advantage of ACP and are facing death unprepared. To compound the issue, many physicians have reported feeling uncomfort- able about approaching palliative care options with patients for many reasons. When characterizing the readiness of clinicians to discuss ACP, one study determined that medical providers were uncomfortable with various ACP terminology and varied in conceptualizations of ACP. Studies have found that ADs specifying limitations in EOL care were associated with significantly lower levels of Medi- care spending and a lower likelihood of in-hospital death. Medicare per capita spending was highest for inpatient services for decedents as compared to living Medicare beneficiaries, suggesting providers are increasing the intensity of services within the last year of life. Money spent on health care during the last year of life uses 25% of all the health care costs in America. From 2003 to 2007, the University of Utah’s health care in-hospital death rate dropped from 31.5% to 21.3%. This decrease is attributed in large part to increased palliative care focus by the medical staff. This study also found that 6.9% of patient deaths in Utah occurred with an ICU stay of seven days or longer, which is similar to rates in other states. The best rate is in La Crosse, Wisconsin, where 2.0% or less die in an ICU and 96% of those who die there have an AD. La Crosse has provided comprehensive education on ACP to its residents and their medical professionals. As a result of increased education, awareness, and conversations between patients and health care professionals, La Crosse, Wisconsin, spends less on health care for patients at the end of life than anywhere else in the U.S. What Are the Differences Between an Advance Directive and POLST? Family physicians know their patient’s entire medical situation since we specialize in taking care of the whole patient. Try looking at the names on your schedule and ask yourself the “surprise question” — “Would I be surprised if this patient died within the next one to two years?” If you would not be surprised, then this patient Advance Care Planning | Continued on page 34 33 |