{
  "abstract": "Background: We examined associations between structured advance care planning (ACP) conversations and outcomes in high-risk hospitalized patients. Methods: We conducted a retrospective cohort study of patients hospitalized on the general medicine service from January 2021-March 2024 who were flagged as high-risk by two algorithms: top quartile of predicted 12-month mortality and ≥20% predicted 30-day readmission. Multivariable generalized linear regression models assessed the association between documented structured ACP conversations and the primary outcome of 30-day readmission. Secondary outcomes included discharge disposition, length of stay, and in-hospital and post-discharge mortality. Results: Among 6,944 high-risk patients, 1,166 (16.8%) had structured ACP documentation. Patients in the ACP group had higher case mix indices, 30-day readmission (49.0% vs. 30.5%), and longer hospital stays (55.5 vs 29.9 days) compared to the No ACP group. Structured ACP was independently associated with 30-day readmission (adjusted OR 2.10; 95% CI, 1.84–2.39). In-hospital mortality was similar (0.2% vs 0.4%), but among those who died post-discharge, time to death was shorter in the ACP group (132.8 vs 159.9 days). Discharge patterns suggested greater hospice referral (adjusted OR 1.25; 95% CI, 0.97–1.62) and lower skilled-nursing facility use (adjusted OR 0.86; 95% CI, 0.73–1.01) in the ACP group. Conclusion: In this cohort of high-risk hospitalized patients, structured ACP conversations associated with a higher 30-day readmission rate and a trend towards hospice discharge. These findings highlight the care complexity of high-risk inpatients and underscore the need for prospective studies to clarify causal effects, optimal timing, and implementation strategies for ACP in the hospital.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Medicine Stanford School of Medicine",
    "Quantitative Sciences Unit Stanford Medicine",
    "Department of Medicine Stanford Medicine",
    "Stanford Medicine",
    "Research Technology Stanford Medicine"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Samantha Wang"
    },
    {
      "affs": [
        1
      ],
      "name": "Megha Tandel"
    },
    {
      "affs": [
        2
      ],
      "name": "Briththa Seevaratnam"
    },
    {
      "affs": [
        3
      ],
      "name": "Rebecca Fong"
    },
    {
      "affs": [
        2
      ],
      "name": "Yingjie Weng"
    },
    {
      "affs": [
        4
      ],
      "name": "Eileen Kiamanesh"
    },
    {
      "affs": [
        2
      ],
      "name": "Lisa Shieh"
    },
    {
      "affs": [
        2
      ],
      "name": "Felicia Hui"
    },
    {
      "affs": [
        2
      ],
      "name": "Winnie Teuteberg"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/bqqyn2z0n4acq.bib",
  "cited_by": 0,
  "doi": "10.56305/001c.168626",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13730620/?tool=EBI",
  "id": "bqqyn2z0n4acq",
  "issns": [
    "2994-5593"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13730620",
  "language": "eng",
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Quality Improvement"
    ],
    [
      "openalex",
      "2739|Palliative Care and End-of-Life Issues"
    ]
  ],
  "openalex": "W7225128828",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13730620/pdf/?tool=EBI",
  "pmcid": "PMC13730620",
  "pmid": "42979625",
  "published": "2026-10-01",
  "publisher": "Department of Medicine of Alpert Medical School of Brown University",
  "ris": "https://research.draconitic.com/paper/bqqyn2z0n4acq.ris",
  "sources": [
    {
      "first_seen": "2026-11-04T15:20:46Z",
      "native_id": "PMC:PMC13730620",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13730620"
    },
    {
      "first_seen": "2026-11-07T12:23:08Z",
      "native_id": "PMC13730620",
      "source": "pmc",
      "url": "https://doi.org/10.56305/001c.168626"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2739|Palliative Care and End-of-Life Issues",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Impact of Structured Advance Care Planning Conversations on Clinical Outcomes in High Risk Hospitalized Patients",
  "title_text": "Impact of Structured Advance Care Planning Conversations on Clinical Outcomes in High Risk Hospitalized Patients",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T12:23:08Z",
  "url": "https://research.draconitic.com/paper/bqqyn2z0n4acq",
  "venue": "Journal of Brown hospital medicine",
  "versions": []
}