Advance Care Planning for People Living with HIV/AIDS

BACKGROUND: The population of PLWHA is aging significantly and HIV incidence is increasing among people over 50. Caring for older adults with HIV requires new thinking to address complex healthcare needs. ACP impacts quality of care and health care costs. However, only 15-25% of adults in the general population complete advance directives. AIDS Healthcare Foundation (AHF) California managed care plans targeted ACP for improvement by promoting completion of advance directives (ADs) by plan members.

METHODS: ACP and AD is encouraged by AHF plans in the primary care setting. In 2010, quantitative and qualitative methods determined low baseline measurement rates and barriers to completion at point of care. Quantitative results obtained through two mandated programs for Medicare and Medicaid beneficiaries: HEDIS (effectiveness of care assessment) and CAHPS (experience of care survey).

RESULTS: The baseline HEDIS AD rate was 4% among Medicare beneficiaries (n=48) in 2010 with remeasure in 2011 increasing to 8%. In 2011, baseline measurement for Medicaid beneficiaries was 7.2% (n=180). The CAHPS Medicare survey showed 44% of respondents reporting an AD (n=261). Interventions to improve performance included electronic medical record prompts for providers and the Five Wishes program.

CONCLUSIONS: Helping consumers understand and document their treatment choices is critical for consumer-directed and cost-effective health care. Creating processes to support providers will ensure treatment plans reflect wishes. This is particularly important for persons with chronic diseases and life-threatening conditions such as HIV/AIDS.