Serious Illness Conversation Impact on End-of-Life Care Utilizations

Abstract

Background: Serious Illness Conversation Programs (SICP) were developed to improve communication with patients with serious illnesses to promote goal concordant care. Limited information is available about whether implementation of an SICP is associated with differential health care utilization. Objective: To determine if care utilization differed for patients with SIC compared to those without. Design: A retrospective cohort study comparing end-of-life care for patients with and without a documented SIC in a large integrated health system after implementation of a SICP. Patients were included if they received a high serious illness score between January 1, 2022, and December 31, 2024, and they died prior to the end of the study period. Measurements: SIC completion and components. Outcome measures were health care utilization in the last 30 days of life within our health system: inpatient admissions/days, ICU admissions/days, emergency department (ED) visits, palliative care, and hospice enrollment/days. Results: Hospice use was higher (32.6% vs. 18.8%, p < 0.001) and ICU admissions were lower (10.9% vs. 13.4%, p = 0.007) among patients who had SIC compared to those without. There was no difference in ED utilization or number of palliative care visits. The proportion of patients with inpatient admissions was higher in the SIC group (44.9% vs. 38.6%, p < 0.001). Conclusion: These findings suggest that while SIC may help define care goals oriented toward reduced utilization of intensive care and increased hospice utilization, further evaluation is needed to understand drivers of ED and inpatient care utilization for patients with a documented SIC.