| Association of age, gender, and race with intensity of end-of-life care for Medicare beneficiaries with cancer. | |
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MedLine Citation:
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PMID: 22468739 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: To measure intensity of end-of-life (EOL) care for Medicare cancer patients and variations in care by age, gender, and race. PATIENTS AND METHODS: This retrospective cohort analysis of Medicare claims (20% sample) examined 235,821 Medicare Parts A and B fee-for-service patients dying with poor-prognosis cancers between 2003 and 2007. Logistic regression models quantified associations between care intensity and age, gender, and race. Measures included hospitalizations, emergency department (ED) visits, intensive care unit (ICU) admissions, in-hospital deaths, late-life chemotherapy administration, overall and late hospice enrollment within six months of death. RESULTS: Within 30 days of death, 61.3% of patients were hospitalized, 10.2% were hospitalized more than once, 10.2% visited an ED more than once, 23.7% had ICU admissions, and 28.8% died in-hospital. Within two weeks of death, 6% received chemotherapy. In their final six months, 55.2% accessed hospice, 15.1% within three days of death. Older age (≥75 versus <75) was associated with lower odds ratios (ORs) of 0.49 to 0.89 for aggressive care, and an OR of 0.92 (95% CI 0.89-0.95) for late hospice enrollment. Female gender was associated with lower ORs (0.82 to 0.86) for aggressive care, and an OR of 0.84 (95% CI 0.81-0.86) for late hospice enrollment. Black (versus nonblack) race was associated with higher ORs (1.08 to 1.38) for aggressive acute care, lower ORs for late chemotherapy, OR 0.76 (95% CI 0.71-0.81), and late hospice enrollment, OR 0.81 (95% CI 0.76-0.86). CONCLUSIONS: Seniors dying with poor-prognosis cancer experience high-intensity care with rates varying by age, gender, and race. |
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Authors:
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Susan Miesfeldt; Kimberly Murray; Lee Lucas; Chiang-Hua Chang; David Goodman; Nancy E Morden |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't Date: 2012-04-02 |
Journal Detail:
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Title: Journal of palliative medicine Volume: 15 ISSN: 1557-7740 ISO Abbreviation: J Palliat Med Publication Date: 2012 May |
Date Detail:
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Created Date: 2012-05-14 Completed Date: 2012-09-28 Revised Date: 2013-05-20 |
Medline Journal Info:
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Nlm Unique ID: 9808462 Medline TA: J Palliat Med Country: United States |
Other Details:
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Languages: eng Pagination: 548-54 Citation Subset: IM |
Affiliation:
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Maine Medical Center Research Institute, Maine Medical Center, Portland, Maine, USA. MIESFS@mmc.org |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Age Factors Aged Continental Population Groups* Female Humans Logistic Models Male Medicare Part A* Medicare Part B* Neoplasms* Retrospective Studies Sex Factors Terminal Care / methods, utilization* United States |
| Grant Support | |
ID/Acronym/Agency:
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P01 AG019783/AG/NIA NIH HHS |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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