Change in end-of-life care for medicare beneficiaries: Site of death, place of care, and health care transitions in 2000, 2005, and 2009

Joan M. Teno, Pedro L. Gozalo, Julie P.W. Bynum, Natalie E. Leland, Susan C. Miller, Nancy E. Morden, Thomas Scupp, David C. Goodman, Vincent Mor

Research output: Contribution to journalArticle

622 Scopus citations

Abstract

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).

Original languageEnglish (US)
Pages (from-to)470-477
Number of pages8
JournalJAMA - Journal of the American Medical Association
Volume309
Issue number5
DOIs
StatePublished - Feb 6 2013

ASJC Scopus subject areas

  • Medicine(all)

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