Change in End-of-Life Care for Medicare Beneficiaries
By J. Teno, P. Gozalo, J. Bynum, N. Leland, Susan C. Miller, N. Morden, Thomas Scupp, D. Goodman, V. Mor. Journal of the American Medical Association (JAMA), 2013
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Importance A recent Centers for Disease Control and Prevention report found that more persons die at home. This has been cited as evidence that persons dying in the United States are using more supportive care. Objective To describe changes in site of death, place of care, and health care transitions between 2000, 2005, and 2009. Design, Setting, and Patients Retrospective cohort study of a random 20% sample of fee-for-service Medicare beneficiaries, aged 66 years and older, who died in 2000 (n=270 202), 2005 (n=291 819), or 2009 (n=286 282). A multivariable regression model examined outcomes in 2000 and 2009 after adjustment for sociodemographic characteristics. Based on billing data, patients were classified as having a medical diagnosis of cancer, chronic obstructive pulmonary disease, or dementia in the last 180 days of life. Main Outcome Measures Site of death, place of care, rates of health care transitions, and potentially burdensome transitions (eg, health care transitions in the last 3 days of life). Results Comparing 2000, 2005, and 2009 shows a decrease in deaths in acute care hospitals and increases in intensive care unit (ICU) use in the last 30 days, hospice use at the time of death, and health care transitions at the end of the life (test of trend P < .001 for each). 2000 2005 2009 No. of decedents 270 202 291 819 286 282 Deaths in acute care hospitals, % (95% CI) 32.6 (32.4–32.8) 26.9 (26.7–27.1) 24.6 (24.5–24.8) ICU use in last month of life, % (95% CI) 24.3 (24.1–24.5) 26.3 (26.1–26.5) 29.2 (29.0–29.3) Hospice use at time of death, % (95% CI) 21.6 (21.4–21.7) 32.3 (32.1–32.5) 42.2 (42.0–42.4) Health care transitions in last 90 d of life per decedent, mean (median) (IQR) 2.1 (1.0) (0–3.0) 2.8 (2.0) (1.0–4.0) 3.1 (2.0) (1.0–5.0) Health care transitions in last 3 days of life, % (95% CI) 10.3 (10.1–10.4) 12.4 (12.3–12.5) 14.2 (14.0–14.3) In 2009, 28.4% (95% CI, 27.9%–28.5%) of hospice use at the time of death was for 3 days or less. Of these late hospice referrals, 40.3% (95% CI, 39.7%–40.8%) were preceded by hospitalization with an ICU stay. Conclusion and Relevance Among Medicare beneficiaries who died in 2009 and 2005 compared with 2000, a lower proportion died in an acute care hospital, although both ICU use and the rate of health care transitions increased in the last month of life.
Subfields: General Health Professions, Geriatrics and Gerontology, Public Health, Environmental and Occupational Health
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In Public Health, Environmental and Occupational Health
Citations in the corpus
- 2016 Alzheimer's disease facts and figures (2016, positive): “Research has also demonstrated a decrease in the proportion of individuals with Alzheimer’s disease who die in an acute care hospital, with end-of-life care shifting to home and nursing homes [338].”