TY - JOUR
T1 - Change in end-of-life care for medicare beneficiaries
T2 - Site of death, place of care, and health care transitions in 2000, 2005, and 2009
AU - Teno, Joan M.
AU - Gozalo, Pedro L.
AU - Bynum, Julie P.W.
AU - Leland, Natalie E.
AU - Miller, Susan C.
AU - Morden, Nancy E.
AU - Scupp, Thomas
AU - Goodman, David C.
AU - Mor, Vincent
PY - 2013/2/6
Y1 - 2013/2/6
N2 - 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).
AB - 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).
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U2 - 10.1001/jama.2012.207624
DO - 10.1001/jama.2012.207624
M3 - Article
C2 - 23385273
AN - SCOPUS:84873264344
SN - 0098-7484
VL - 309
SP - 470
EP - 477
JO - JAMA
JF - JAMA
IS - 5
ER -