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Emergency Care Use and the Medicare Hospice Benefit for Individuals with Cancer with a Poor Prognosis
Author(s) -
Obermeyer Ziad,
Clarke Alissa C.,
Makar Maggie,
Schuur Jeremiah D.,
Cutler David M.
Publication year - 2016
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.13948
Subject(s) - medicine , emergency department , confidence interval , emergency medicine , cancer , hospice care , palliative care , psychiatry , nursing
Objectives To compare patterns of emergency department ( ED ) use and inpatient admission rates for elderly adults with cancer with a poor prognosis who enrolled in hospice to those of similar individuals who did not. Design Matched case–control study. Setting Nationally representative sample of Medicare fee‐for‐service beneficiaries with cancer with a poor prognosis who died in 2011. Participants Beneficiaries in hospice matched to individuals not in hospice on time from diagnosis of cancer with a poor prognosis to death, region, age, and sex. Measurements Comparison of ED use and inpatient admission rates before and after hospice enrollment for beneficiaries in hospice and controls. Results Of 272,832 matched beneficiaries, 81% visited the ED in the last 6 months of life. At baseline, daily ED use and admission rates were not significantly different between beneficiaries in and not in hospice. By the week before death, nonhospice controls averaged 69.6 ED visits/1,000 beneficiary‐days, versus 7.6 for beneficiaries in hospice (rate ratio ( RR ) = 9.7, 95% confidence interval ( CI ) = 9.3–10.0). Inpatient admission rates in the last week of life were 63% for nonhospice controls and 42% for beneficiaries in hospice ( RR = 1.51, 95% CI = 1.45–1.57). Of all beneficiaries in hospice, 28% enrolled during inpatient stays originating in ED s; they accounted for 35.7% (95% CI = 35.4–36.0%) of all hospice stays of less than 1 month and 13.9% (95% CI = 13.6–14.2%) of stays longer than 1 month. Conclusion Most Medicare beneficiaries with cancer with a poor prognosis visited ED s at the end of life. Hospice enrollment was associated with lower ED use and admission rates. Many individuals enrolled in hospice during inpatient stays that followed ED visits, a phenomenon linked to shorter hospice stays. These findings must be interpreted carefully given potential unmeasured confounders in matching.