SON faculty Hewner, Wu and PhD student Suzanne Sullivan published in Journal of Nursing Administration

advance care planning documents

Published November 30, 2017

Associate Professors Sharon Hewner and Bill Wu and PhD student Suzanne Sullivan were published in the November 2017 issue of Journal of Nursing Administration for their study, “Complexity of Chronic Conditions’ Impact on End-of-Life Expense Trajectories of Medicare Decedents.” Junxin Li, UB SON PhD alumna and postdoctoral research fellow at University of Pennsylvania’s Perelman School of Medicine, is also a co-author on the study.

Improving Care Through Research

The purpose of the study was to determine if certain data sets can be used to guide clinical decisions, specifically end-of-life discussions and care for Medicare beneficiaries with a life-limiting illness.

The researchers analyzed de-identified Medicare data of deceased individuals to determine if there is a relationship between complex conditions – chronic disease, system failure and frailty, and cancer – and patterns of monthly medical expenses. They found that, on average, the monthly expenses increase more rapidly in the last three months of life compared to the first nine months of the final year of life. Conversely, those who elected to use their hospice benefit have higher monthly expenses in the first nine months of their final year of life and lower monthly expenses in the final three months.

The researchers conclude that the condition type can be used to group these individuals into different cost trajectories for medical expenses at the end of life. They also suggest that when monthly expenses are more than $2,000 for non-cancer diagnoses, administrative data can be used to identify patients who would benefit from advance care planning discussions and supportive care program resources. By identifying high-risk cases earlier, nurses can be empowered to better assist these patients in making their end-of-life wishes known and to engage in advance care planning.

Read More

Sullivan, S., Li, J., Wu, Y.-W. B., & Hewner, S. (2017). Complexity of chronic conditions’ impact on end-of-life expense trajectories of Medicare decedents. Journal of Nursing Administration, (47)11, 545-550. doi:10.1097/NNA.0000000000000541