In Health services research
OBJECTIVE : To construct a new measure of end-of-life (EoL) spending-the elevated EoL spending-and examine its associations with measures of quality of care and patient and physician preferences, in comparison with the commonly used total Medicare EoL spending measures.
DATA SOURCES AND STUDY SETTING : 2015-2016 Medicare claims data for a 20% random sample of Medicare fee-for-service (FFS) patients, healthcare quality data from the Hospital Compare and the Medicare Geographic Variation public use file, and survey data about patient and physician preferences.
STUDY DESIGN : We constructed the elevated EoL spending measure as the differential monthly spending between decedents and survivors with the same one-year mortality risk, where the risk was predicted using machine learning models. We then examined the associations of the hospital referral region (HRR)-level elevated EoL spending with various healthcare quality measures, and with survey-elicited patient and provider preferences. We also examined analogous associations for monthly total EoL spending on decedents.
DATA EXTRACTION METHODS : Medicare FFS patients who were continuously enrolled in Medicare Parts A & B in 2015 and were alive as of January 1, 2016.
PRINCIPAL FINDINGS : We found large variation in the elevated EoL spending across HRRs in the U.S. There was no evidence of an association between HRR-level elevated EoL spending and established healthcare quality measures, including those specific to EoL care, whereas total EoL spending was positively associated with certain quality of care measures. We also found no evidence that elevated EoL spending was associated with patient preferences for EoL care. However, elevated EoL spending was positively and significantly associated with physician preferences for treatment intensity.
CONCLUSIONS : Our findings suggested that elevated EoL spending captures different resource use from conventional measures of EoL spending, and may be more valuable in identifying potentially wasteful spending. This article is protected by copyright. All rights reserved.
Zhang Yongkang, Gupta Atul, Nicholson Sean, Li Jing
2022-Oct-27
End-of-life, Medicare, healthcare quality, patient preferences, physician preferences, waste in healthcare
