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BMC Health Serv Res. 2015 Dec 9;15:545. doi: 10.1186/s12913-015-1201-9.

Costs and advance directives at the end of life: a case of the 'Coaching Older Adults and Carers to have their preferences Heard (COACH)' trial.

Author information

1
Flinders Health Economics group, Flinders University, A Block, Repatriation General Hospital, 202-16 Daws Road, Daw Park, SA, 5041, Adelaide, Australia. billingsley.kaambwa@flinders.edu.au.
2
Billingsley Kaambwa, Flinders Health Economics Group, School of Medicine, Flinders University, Repatriation General Hospital, 202-16 Daws Road, Daw Park, SA, 5041, Australia. billingsley.kaambwa@flinders.edu.au.
3
Flinders Health Economics group, Flinders University, A Block, Repatriation General Hospital, 202-16 Daws Road, Daw Park, SA, 5041, Adelaide, Australia. Julie.ratcliffe@flinders.edu.au.
4
CareSearch, Palliative care knowledge network, Palliative and Supportive Services, Flinders University, PO Box 2100, Adelaide, SA, 5001, Australia. sandra.bradley@flinders.edu.au.
5
The Discipline of General Practice, Health Sciences Building, Flinders University, GPO Box 2100, SA, 5001, Adelaide, Australia. stacey.masters@flinders.edu.au.
6
Department of Rehabilitation and Aged Care, Flinders University, C Block, Repatriation General Hospital, 202-16 Daws Road, Daw Park, SA, 5041, Adelaide, Australia. owen.davies@flinders.edu.au.
7
Department of Rehabilitation and Aged Care, Flinders University, C Block, Repatriation General Hospital, 202-16 Daws Road, Daw Park, SA, 5041, Adelaide, Australia. craig.whitehead@health.sa.gov.au.
8
School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood, VIC, 3125, Melbourne, Australia. catherine.milte@deakin.edu.au.
9
John Walsh Centre for Rehabilitation Research, University of Sydney, Level 13, Kolling Institute of Medical Research, Corner Reserve Road and Westbourne Avenue, Royal North Shore Hospital, St Leonards, NSW, 2065, Sydney, Australia. ian.cameron@sydney.edu.au.
10
School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK. t.a.young@sheffield.ac.uk.
11
Discipline of Public Health, University of Adelaide, 178 North Terrace, Terrace Towers, SA, 5005, Adelaide, Australia. jason.gordon@adelaide.edu.au.
12
Department of Rehabilitation and Aged Care, Flinders University, C Block, Repatriation General Hospital, 202-16 Daws Road, Daw Park, SA, 5041, Adelaide, Australia. maria.crotty@flinders.edu.au.

Abstract

BACKGROUND:

Total costs associated with care for older people nearing the end of life and the cost variations related with end of life care decisions are not well documented in the literature. Healthcare utilisation and associated health care costs for a group of older Australians who entered Transition Care following an acute hospital admission were calculated. Costs were differentiated according to a number of health care decisions and outcomes including advance directives (ADs).

METHODS:

Study participants were drawn from the Coaching Older Adults and Carers to have their preferences Heard (COACH) trial funded by the Australian National Health and Medical Research Council. Data collected included total health care costs, the type of (and when) ADs were completed and the place of death. Two-step endogenous treatment-regression models were employed to test the relationship between costs and a number of variables including completion of ADs.

RESULTS:

The trial recruited 230 older adults with mean age 84 years. At the end of the trial, 53 had died and 80 had completed ADs. Total healthcare costs were higher for younger participants and those who had died. No statistically significant association was found between costs and completion of ADs.

CONCLUSION:

For our frail study population, the completion of ADs did not have an effect on health care utilisation and costs. Further research is needed to substantiate these findings in larger and more diverse clinical cohorts of older people.

TRIAL REGISTRATION:

This study was registered on 13/12/2007 with the Australian New Zealand Clinical Trial Registry ( ACTRN12607000638437 ).

PMID:
26645745
PMCID:
PMC4673742
DOI:
10.1186/s12913-015-1201-9
[Indexed for MEDLINE]
Free PMC Article

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