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Intensity of end‐of‐life care for dual‐eligible beneficiaries with cancer and the impact of delivery system affiliation
Author(s) -
Herrel Lindsey A.,
Zhu Ziwei,
Ryan Andrew M.,
Hollenbeck Brent K.,
Miller David C.
Publication year - 2021
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.33874
Subject(s) - medicine , medicaid , logistic regression , receipt , population , end of life care , epidemiology , cancer , quality of life (healthcare) , palliative care , family medicine , emergency medicine , gerontology , health care , environmental health , nursing , world wide web , computer science , economics , economic growth
Background Dual‐eligible beneficiaries, who qualify for Medicare and Medicaid, are a vulnerable population with much to gain from efforts to improve quality. Integrated delivery networks and cancer centers, with their emphasis on care coordination and communication, may improve quality of care for dual‐eligible patients with cancer at the end of life. Methods This study used Surveillance, Epidemiology, and End Results registry data linked with Medicare claims to evaluate quality for beneficiaries who died of cancer and were diagnosed from 2009 to 2014. High‐intensity care was evaluated with 7 end‐of‐life quality measures according to dual‐eligible status with multivariable logistic regression models. Regression‐based techniques were used to assess the effect of delivery system affiliation (ie, cancer center or integrated delivery network vs no affiliation). Results Among 100,549 beneficiaries who died during the study interval, 22% were dually eligible. Inferior outcomes were identified for dual‐eligible beneficiaries in comparison with nondual beneficiaries across nearly every quality measure assessed, including >1 hospitalization in the last 30 days (12.6% vs 11.3%; P < .001) and a greater proportion of deaths occurring in a hospital setting (30.2% vs 26.2%; P < .001). Receipt of care in an affiliated delivery system was associated with reduced deaths in a hospital setting and increased hospice utilization for dual‐eligible beneficiaries. Conclusions Dual‐eligible status is associated with higher intensity care at the end of life. Delivery system affiliation has a modest impact on quality at the end of life, and this suggests that targeted efforts may be needed to optimize quality for this group of vulnerable patients.