How U.S. Doctors Die: A Cohort Study of Healthcare Use at the End of Life
Objectives To compare healthcare use in the last months of life between physicians and nonphysicians in the United States. Design A retrospective observational cohort study. Setting United States. Participants Fee‐for‐service Medicare beneficiaries: decedent physicians (n = 9,947) and a random sampl...
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| Published in | Journal of the American Geriatrics Society (JAGS) Vol. 64; no. 5; pp. 1061 - 1067 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Blackwell Publishing Ltd
01.05.2016
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0002-8614 1532-5415 1532-5415 |
| DOI | 10.1111/jgs.14112 |
Cover
| Abstract | Objectives
To compare healthcare use in the last months of life between physicians and nonphysicians in the United States.
Design
A retrospective observational cohort study.
Setting
United States.
Participants
Fee‐for‐service Medicare beneficiaries: decedent physicians (n = 9,947) and a random sample of Medicare decedents (n = 192,006).
Measurements
Medicare Part A claims data from 2008 to 2010 were used to measure days in the hospital and proportion using hospice in the last 6 months of life as primary outcome measures adjusted for sociodemographic characteristics and regional variations in health care.
Results
Inpatient hospital use in the last 6 months of life was no different between physicians and nonphysicians, although more physicians used hospice and for longer (using the hospital: odds ratio (OR) = 0.98, 95% confidence interval (CI) = 0.93–1.04; hospital days: mean difference 0.26, P = .14); dying in the hospital: OR = 0.99, 95% CI = 0.95–1.04; intensive care unit (ICU) or critical care unit (CCU) days: mean difference 0.35 more days for physicians, P < .001); using hospice: OR = 1.23, 95% CI = 1.18–1.29; number of days in hospice: mean difference 2.06, P < .001).
Conclusion
This retrospective, observational study is subject to unmeasured confounders and variation in coding practices, but it provides preliminary evidence of actual use. U.S. physicians were more likely to use hospice and ICU‐ or CCU‐level care. Hospitalization rates were similar. |
|---|---|
| AbstractList | To compare healthcare use in the last months of life between physicians and nonphysicians in the United States.OBJECTIVESTo compare healthcare use in the last months of life between physicians and nonphysicians in the United States.A retrospective observational cohort study.DESIGNA retrospective observational cohort study.United States.SETTINGUnited States.Fee-for-service Medicare beneficiaries: decedent physicians (n = 9,947) and a random sample of Medicare decedents (n = 192,006).PARTICIPANTSFee-for-service Medicare beneficiaries: decedent physicians (n = 9,947) and a random sample of Medicare decedents (n = 192,006).Medicare Part A claims data from 2008 to 2010 were used to measure days in the hospital and proportion using hospice in the last 6 months of life as primary outcome measures adjusted for sociodemographic characteristics and regional variations in health care.MEASUREMENTSMedicare Part A claims data from 2008 to 2010 were used to measure days in the hospital and proportion using hospice in the last 6 months of life as primary outcome measures adjusted for sociodemographic characteristics and regional variations in health care.Inpatient hospital use in the last 6 months of life was no different between physicians and nonphysicians, although more physicians used hospice and for longer (using the hospital: odds ratio (OR) = 0.98, 95% confidence interval (CI) = 0.93-1.04; hospital days: mean difference 0.26, P = .14); dying in the hospital: OR = 0.99, 95% CI = 0.95-1.04; intensive care unit (ICU) or critical care unit (CCU) days: mean difference 0.35 more days for physicians, P < .001); using hospice: OR = 1.23, 95% CI = 1.18-1.29; number of days in hospice: mean difference 2.06, P < .001).RESULTSInpatient hospital use in the last 6 months of life was no different between physicians and nonphysicians, although more physicians used hospice and for longer (using the hospital: odds ratio (OR) = 0.98, 95% confidence interval (CI) = 0.93-1.04; hospital days: mean difference 0.26, P = .14); dying in the hospital: OR = 0.99, 95% CI = 0.95-1.04; intensive care unit (ICU) or critical care unit (CCU) days: mean difference 0.35 more days for physicians, P < .001); using hospice: OR = 1.23, 95% CI = 1.18-1.29; number of days in hospice: mean difference 2.06, P < .001).This retrospective, observational study is subject to unmeasured confounders and variation in coding practices, but it provides preliminary evidence of actual use. U.S. physicians were more likely to use hospice and ICU- or CCU-level care. Hospitalization rates were similar.CONCLUSIONThis retrospective, observational study is subject to unmeasured confounders and variation in coding practices, but it provides preliminary evidence of actual use. U.S. physicians were more likely to use hospice and ICU- or CCU-level care. Hospitalization rates were similar. Objectives To compare healthcare use in the last months of life between physicians and nonphysicians in the United States. Design A retrospective observational cohort study. Setting United States. Participants Fee‐for‐service Medicare beneficiaries: decedent physicians (n = 9,947) and a random sample of Medicare decedents (n = 192,006). Measurements Medicare Part A claims data from 2008 to 2010 were used to measure days in the hospital and proportion using hospice in the last 6 months of life as primary outcome measures adjusted for sociodemographic characteristics and regional variations in health care. Results Inpatient hospital use in the last 6 months of life was no different between physicians and nonphysicians, although more physicians used hospice and for longer (using the hospital: odds ratio (OR) = 0.98, 95% confidence interval (CI) = 0.93–1.04; hospital days: mean difference 0.26, P = .14); dying in the hospital: OR = 0.99, 95% CI = 0.95–1.04; intensive care unit (ICU) or critical care unit (CCU) days: mean difference 0.35 more days for physicians, P < .001); using hospice: OR = 1.23, 95% CI = 1.18–1.29; number of days in hospice: mean difference 2.06, P < .001). Conclusion This retrospective, observational study is subject to unmeasured confounders and variation in coding practices, but it provides preliminary evidence of actual use. U.S. physicians were more likely to use hospice and ICU‐ or CCU‐level care. Hospitalization rates were similar. To compare healthcare use in the last months of life between physicians and nonphysicians in the United States. A retrospective observational cohort study. United States. Fee-for-service Medicare beneficiaries: decedent physicians (n = 9,947) and a random sample of Medicare decedents (n = 192,006). Medicare Part A claims data from 2008 to 2010 were used to measure days in the hospital and proportion using hospice in the last 6 months of life as primary outcome measures adjusted for sociodemographic characteristics and regional variations in health care. Inpatient hospital use in the last 6 months of life was no different between physicians and nonphysicians, although more physicians used hospice and for longer (using the hospital: odds ratio (OR) = 0.98, 95% confidence interval (CI) = 0.93-1.04; hospital days: mean difference 0.26, P = .14); dying in the hospital: OR = 0.99, 95% CI = 0.95-1.04; intensive care unit (ICU) or critical care unit (CCU) days: mean difference 0.35 more days for physicians, P < .001); using hospice: OR = 1.23, 95% CI = 1.18-1.29; number of days in hospice: mean difference 2.06, P < .001). This retrospective, observational study is subject to unmeasured confounders and variation in coding practices, but it provides preliminary evidence of actual use. U.S. physicians were more likely to use hospice and ICU- or CCU-level care. Hospitalization rates were similar. |
| Author | Kelley, Amy S. Matlock, Daniel D. Smith, Alexander K. Yamashita, Traci E. M. Fischer, Stacy Min, Sung-Joon |
| Author_xml | – sequence: 1 givenname: Daniel D. surname: Matlock fullname: Matlock, Daniel D. email: daniel.matlock@ucdenver.edu organization: Division of Geriatrics, School of Medicine, University of Colorado, Colorado, Aurora – sequence: 2 givenname: Traci E. surname: Yamashita fullname: Yamashita, Traci E. organization: Undergraduate Medical Education, School of Medicine, University of Colorado, Aurora, Colorado – sequence: 3 givenname: Sung-Joon surname: Min fullname: Min, Sung-Joon organization: Division of Health Care Policy and Research, School of Medicine, University of Colorado, Aurora, Colorado – sequence: 4 givenname: Alexander K. surname: Smith fullname: Smith, Alexander K. organization: Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California – sequence: 5 givenname: Amy S. surname: Kelley fullname: Kelley, Amy S. organization: Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York – sequence: 6 givenname: Stacy surname: M. Fischer fullname: M. Fischer, Stacy organization: Division of General Internal Medicine, School of Medicine, University of Colorado, Aurora, Colorado |
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| References_xml | – reference: Earle CC, Park ER, Lai B et al. Identifying potential indicators of the quality of end-of-life cancer care from administrative data. J Clin Oncol 2003;21:1133-1138. – reference: Fisher ES, Bynum JP, Skinner JS. Slowing the growth of health care costs-lessons from regional variation. N Engl J Med 2009;360:849-852. – reference: Chernew ME, Goldman DP, Pan F et al. Disability and health care spending among Medicare beneficiaries. Health Aff (Millwood) 2005;24(Suppl 2):W5R42-W5R52. – reference: Orszag PR, Emanuel EJ. Health care reform and cost control. N Engl J Med 2010;363:601-603. – reference: Zhang B, Wright AA, Huskamp HA et al. Health care costs in the last week of life: Associations with end-of-life conversations. Arch Intern Med 2009;169:480-488. – reference: Zarabozo C, Harrison S. Payment policy and the growth of Medicare advantage. Health Aff (Millwood) 2009;28:w55-w67. – reference: Earle CC, Neville BA, Landrum MB et al. 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To compare healthcare use in the last months of life between physicians and nonphysicians in the United States.
Design
A retrospective observational... To compare healthcare use in the last months of life between physicians and nonphysicians in the United States. A retrospective observational cohort study.... To compare healthcare use in the last months of life between physicians and nonphysicians in the United States.OBJECTIVESTo compare healthcare use in the last... |
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| SubjectTerms | Aged end of life Female hospice Hospices - statistics & numerical data Hospitalization - statistics & numerical data Humans Intensive Care Units - statistics & numerical data Male Medicare Medicare Part A Physicians Retrospective Studies Socioeconomic Factors Terminal Care - statistics & numerical data United States - epidemiology |
| Title | How U.S. Doctors Die: A Cohort Study of Healthcare Use at the End of Life |
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