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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Dana B. Mukamel, Alina Bajorska, and Helena Temkin-Greener, PhD. Department of Community and Preventive Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 644, Rochester, NY 14642, (585) 275-1985, dana_mukamel@urmc.rochester.edu
The period preceding death is often characterized by increased utilization of medical resources. This study investigates end-of-life practices in PACE, a Medicare/Medicaid managed care program, which integrates primary, acute, long term and hospice care. We focus on the contribution of individual characteristics versus program site to the variation in use of services in order to answer the question: Does end-of-life care depend on who the patient is or where the patient lives? Monthly utilization for the last 3 years prior to death was measured for 12 services accounting for 89% of total expenditures. Individual characteristics for each month included socio-economic and demographic information, health and cognitive status. Multivariate regression techniques were used to estimate models predicting utilization of services by month conditional on individual characteristics and program site. A complex error structure, allowing for individual random time from death effects and an individual autoregressive error process were assumed. The percent of variation explained by individual characteristics and program sites in relation to time from death was estimated. The study included 2160 individuals enrolled in 10 PACE sites who died prior to 2000. Utilization of services increased as early as 7 months prior to death, with the largest increase in the last month. The increase was dominated by hospital use. As time to death nears, the importance of individual characteristics in explaining variation in utilization of services diminished. The percent of the variation in monthly utilization explained by individual characteristics declined and the percent explained by program site increases.
Learning Objectives:
Keywords: End-of-Life Care,
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.