# Identifying barriers, facilitators and outcomes of Advanced Care Planning conversations with Medicare patients

> **NIH NIH R01** · BRIGHAM AND WOMEN'S HOSPITAL · 2020 · $687,612

## Abstract

Project Summary/Abstract
 Although the use of palliative and hospice care for terminally ill Medicare patients is growing, large numbers
of Americans die following intensive, non-curative, burdensome treatments. Available evidence suggests that
advanced care planning (ACP) discussions are associated with less aggressive end-of-life (EOL) care, greater
concordance between the care patients prefer and the care they receive, and perhaps improved bereavement
outcomes for caregivers. However, national data on the uptake and impact of ACP are lacking.
 As a result of a new policy from the Centers for Medicare & Medicaid Services (CMS), effective January 1,
2016, clinicians may now bill for having ACP discussions with their patients. This provides an unprecedented
opportunity to study the use and impact of these discussions on a national population basis. Importantly, these
services are reimbursable whether they are provided by physicians or nurses in any setting.
 The proposed study will use both quantitative and qualitative methods to provide a unique scientific
examination of the use of ACP discussions and their impact on the intensity and outcomes of care received by
seriously ill patients nearing the end of life. We propose the following aims:
 Aim 1) To identify trends in use and factors associated with Medicare ACP discussions. Using
Medicare claims files, we will examine the number and types of patients who have ACP discussions
documented by their clinicians, factors associated with ACP use, and trends over time in ACP uptake.
 Aim 2) To examine the impact of ACP discussions on EOL intensity among seriously ill patients.
Using Medicare claims files, we will build a prospective cohort of seriously ill patients and examine the effect of
ACP conversations on patients' EOL intensity.
 Aim 3) To identify barriers and facilitators of conducting ACP discussions in clinical settings. Using
qualitative methods (case studies, focus groups, semi-structured interviews), we will examine patients',
clinicians', and other stakeholders' perceived barriers and facilitators to the use of ACP, as well as explore
implications of ACP conversations with respect to clinical workflow.
 It is hoped that by further understanding utilization patterns of ACP use and accompanying barriers and
facilitators to implementation may influence patient care. We expect that the findings of the proposed analyses
will serve to advise health systems and policymakers on how best to direct resources and address potential
inequities relating to ACP conversations and, more broadly, inform the viability of targeting ACP as a primary
vehicle for change, as opposed to other aspects of the EOL care delivery system.

## Key facts

- **NIH application ID:** 9967156
- **Project number:** 5R01NR017034-04
- **Recipient organization:** BRIGHAM AND WOMEN'S HOSPITAL
- **Principal Investigator:** Joel S. Weissman
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $687,612
- **Award type:** 5
- **Project period:** 2017-09-11 → 2022-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9967156

## Citation

> US National Institutes of Health, RePORTER application 9967156, Identifying barriers, facilitators and outcomes of Advanced Care Planning conversations with Medicare patients (5R01NR017034-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9967156. Licensed CC0.

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