PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of canfamphysLink to Publisher's site
 
Can Fam Physician. 1999 October; 45: 2408–2413.
PMCID: PMC2328634

How advance directives affect hospital resource use. Systematic review of the literature.

Abstract

OBJECTIVE: To assess whether advance directives influence resource use by hospitalized patients. DATA SOURCES: A systematic search of computerized medical databases, reference lists from relevant articles, and personal files was conducted to identify studies examining the association between advance directives and resource use. STUDY SELECTION: Primary studies assessing the effect of advance directives on hospital resource use were selected if they had a clear quantitative measure of hospital resource use, hospitalized patients as a study population, a control group for comparison, and a description of the advance directive being studied. Data on the following topics were abstracted from studies meeting inclusion criteria: study methods and design, resource use, source of financial data, description of advance directive, population size and composition, length of assessment. SYNTHESIS: Six studies met inclusion criteria. Three retrospective studies showed significant reductions in resource use associated with documentation of advance directives while three prospective studies (two randomized, one not randomized) showed no association between advance directives and reduced resource use. Studies were limited to narrowly defined patient populations in US tertiary care hospitals. CONCLUSIONS: Little evidence supports the hypothesis that advance directives reduce resource use by hospitalized patients. Some retrospective studies have shown savings, but their conclusions are weakened by shortcomings in study design. Prospective trials, which have better experimental methods, have demonstrated no evidence of cost savings with the use of advance directives.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.7M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Tonelli MR. Pulling the plug on living wills. A critical analysis of advance directives. Chest. 1996 Sep;110(3):816–822. [PubMed]
  • Emanuel LL, Emanuel EJ. The Medical Directive. A new comprehensive advance care document. JAMA. 1989 Jun 9;261(22):3288–3293. [PubMed]
  • Advance directives: are they an advance? Advance Directives Seminar Group, Centre for Bioethics, University of Toronto. CMAJ. 1992 Jan 15;146(2):127–134. [PMC free article] [PubMed]
  • Emanuel LL, Barry MJ, Stoeckle JD, Ettelson LM, Emanuel EJ. Advance directives for medical care--a case for greater use. N Engl J Med. 1991 Mar 28;324(13):889–895. [PubMed]
  • Emanuel EJ, Emanuel LL. The economics of dying. The illusion of cost savings at the end of life. N Engl J Med. 1994 Feb 24;330(8):540–544. [PubMed]
  • Emanuel L. Structured advance planning. Is it finally time for physician action and reimbursement? JAMA. 1995 Aug 9;274(6):501–503. [PubMed]
  • Chambers CV, Diamond JJ, Perkel RL, Lasch LA. Relationship of advance directives to hospital charges in a Medicare population. Arch Intern Med. 1994 Mar 14;154(5):541–547. [PubMed]
  • Lubitz J, Prihoda R. The use and costs of Medicare services in the last 2 years of life. Health Care Financ Rev. 1984 Spring;5(3):117–131. [PubMed]
  • Fries JF, Koop CE, Beadle CE, Cooper PP, England MJ, Greaves RF, Sokolov JJ, Wright D. Reducing health care costs by reducing the need and demand for medical services. The Health Project Consortium. N Engl J Med. 1993 Jul 29;329(5):321–325. [PubMed]
  • Coppa S. Futile care: confronting the high costs of dying. J Nurs Adm. 1996 Dec;26(12):18–23. [PubMed]
  • Gillick M. The high costs of dying. A way out. Arch Intern Med. 1994 Oct 10;154(19):2134–2137. [PubMed]
  • Cook DJ, Mulrow CD, Haynes RB. Systematic reviews: synthesis of best evidence for clinical decisions. Ann Intern Med. 1997 Mar 1;126(5):376–380. [PubMed]
  • Emanuel EJ. Cost savings at the end of life. What do the data show? JAMA. 1996 Jun 26;275(24):1907–1914. [PubMed]
  • Maksoud A, Jahnigen DW, Skibinski CI. Do not resuscitate orders and the cost of death. Arch Intern Med. 1993 May 24;153(10):1249–1253. [PubMed]
  • Teno JM, Lynn J, Phillips RS, Murphy D, Youngner SJ, Bellamy P, Connors AF, Jr, Desbiens NA, Fulkerson W, Knaus WA. Do formal advance directives affect resuscitation decisions and the use of resources for seriously ill patients? SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. J Clin Ethics. 1994 Spring;5(1):23–30. [PubMed]
  • Weeks WB, Kofoed LL, Wallace AE, Welch HG. Advance directives and the cost of terminal hospitalization. Arch Intern Med. 1994 Sep 26;154(18):2077–2083. [PubMed]
  • Schneiderman LJ, Kronick R, Kaplan RM, Anderson JP, Langer RD. Effects of offering advance directives on medical treatments and costs. Ann Intern Med. 1992 Oct 1;117(7):599–606. [PubMed]
  • Finkler SA. The distinction between cost and charges. Ann Intern Med. 1982 Jan;96(1):102–109. [PubMed]

Articles from Canadian Family Physician are provided here courtesy of College of Family Physicians of Canada