THE CARE SPAN: End-Of-Life Care For Medicare Beneficiaries With Cancer Is Highly Intensive Overall And Varies Widely

Studies have shown that cancer care near the end of life is more aggressive than many patients prefer. Using a cohort of deceased Medicare beneficiaries with poor-prognosis cancer, meaning that they were likely to die within a year, we examined the association between hospital characteristics and el...

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Bibliographic Details
Published in:Health affairs (Millwood, Va.) Va.), 2012-04, Vol.31 (4), p.786
Main Authors: Morden, Nancy E, Chang, Chiang-Hua, Jacobson, Joseph O, Berke, Ethan M, Bynum, Julie PW, Murray, Kimberly M, Goodman, David C
Format: Article
Language:English
Subjects:
Beneficiaries
Best practice
Cancer
Chemotherapy
Codes
Death & dying
Disease
Hospice care
Hospitals
Intensive care
Medical prognosis
Medicare
Palliative care
Patients
Prostate cancer
Quality improvement
Studies
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Summary:Studies have shown that cancer care near the end of life is more aggressive than many patients prefer. Using a cohort of deceased Medicare beneficiaries with poor-prognosis cancer, meaning that they were likely to die within a year, we examined the association between hospital characteristics and eleven end-of-life care measures, such as hospice use and hospitalization. Our study revealed a relatively high intensity of care in the last weeks of life. At the same time, there was more than a twofold variation within hospital groups with common features, such as cancer center designation and for-profit status. We found that these hospital characteristics explained little of the observed variation in intensity of end-of-life cancer care and that none reliably predicted a specific pattern of care. These findings raise questions about what factors may be contributing to this variation. They also suggest that best practices in end-of-life cancer care can be found in many settings and that efforts to improve the quality of end-of-life care should include every hospital category. [PUBLICATION ABSTRACT]
ISSN:0278-2715
1544-5208
DOI:10.1377/hlthaff.2011.0650