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Place of Death of Individuals with Terminal Cancer: New Insights from Medicare Hospice Place‐of‐Service Codes
Author(s) -
Jarosek Stephanie L.,
Shippee Tetyana P.,
Virnig Beth A.
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.14269
Subject(s) - medicine , hospice care , place of death , end of life care , odds ratio , family medicine , odds , retrospective cohort study , cancer , gerontology , palliative care , logistic regression , emergency medicine , nursing
Objectives To use place‐of‐service ( POS ) codes in the Medicare hospice claims files to document where elderly hospice users with cancer die. Design Retrospective cohort study. Setting Surveillance, Epidemiology, and End Results ( SEER ) cancer registry areas. Participants Elderly Medicare beneficiaries who died of lung, breast, colorectal, or pancreatic cancer in 2007 and 2008 (N = 46,037). Measurement Use of hospice, place of service at death (home, nursing home, hospital, inpatient hospice, other), length of stay in hospice. Results Two‐thirds of the beneficiaries used hospice. Younger, male, black, Asian, and unmarried beneficiaries and those enrolled in fee‐for‐service Medicare or from areas with lower income were less likely to use hospice. Hospice enrollment also varied significantly according to SEER registry. Thirty percent of the hospice users were not receiving home‐based care at the time of death, and 17% were enrolled for less than 3 days. Factors associated with hospice death in the home mirrored those associated with hospice use. Individuals dying in hospitals (odds ratio ( OR ) = 5.13, 95% confidence interval ( CI ) = 4.63–5.69), inpatient hospice ( OR = 1.86, 95% CI = 1.70–2.02), and nursing homes ( OR = 1.19, 95% CI = 1.10–1.28) had greater odds of a short hospice stay (≤7 days) than those dying at home, after controlling for all other measured factors, whereas those dying in nursing homes had greater odds of long stays (>180 days) ( OR = 1.46, 95% CI = 1.28–1.67). Conclusion New hospice POS codes are useful for understanding place of death for hospice users. Hospice deaths cannot be assumed to happen at home.