How advance directives affect hospital resource use - Systematic review ofthe literature

OBJECTIVE To assess whether advance directives influence resource use by ho spitalized patients. DATA SOURCES A systematic search of computerized medical databases, referen ce lists from relevant articles, and personal files was conducted to identi fy studies examining the association between advance directives and resourc e use. STUDY SELECTION Primary studies assessing the effect of advance directives on hospital resource use were selected if they had a clear quantitative mea sure 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 m eeting inclusion criteria: study methods and design, resource use, source o f financial data, description of advance directive, population size and com position, length of assessment. SYNTHESIS Six studies met inclusion criteria. Three retrospective studies s howed 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 reduce d resource use. Studies were limited to narrowly defined patient population s in US tertiary care hospitals. CONCLUSIONS Little evidence supports the hypothesis that advance directives reduce resource use by hospitalized patients. Some retrospective studies h ave shown savings, but their conclusions are weakened by shortcomings in st udy design. Prospective trials, which have better experimental methods, hav e demonstrated no evidence of cost savings with the use of advance directiv es.