Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #109221

Irina V. Haller, PhD, MS, Division of Education & Research, St. Mary's/Duluth Clinic Health System , 5AV2ME, 400 E 3rd St, Duluth, MN 55805, 218 786 8185, ihaller@smdc.org and Charles E. Gessert, MD, MPH, Division of Education and Research, St. Mary's/Duluth Clinic Health System, 400 East 3rd Street, Duluth, MN 55805-1853.

Objective: To characterize elderly nursing home residents with dementia who had high medical services utilization (MSU) near end of life. Methods: Elderly residents of Minnesota and Texas nursing homes (urban and rural), who had severe and chronic cognitive impairment, and who died during 2000-2001 were included in the study population. Medicare Denominator, MedPAR, Hospice, and Minimum Data Set files were used to document MSU. Subjects enrolled in HMOs and Hospice programs were excluded, as well as those in coma. MSU outliers were defined as subjects with 7+ ICU days in the last 90 days of life. Results: The study population was 3710: 1494 (40.3%) were hospitalized at least once during the study period, 82 (2.2%) met the outlier criteria. In bivariate analysis: the outliers were likely to be less than 88 years old (OR2.2, 95% CI 1.4-3.5), non-white race (OR6.2, 4.0-9.7); to reside in an urban county (OR7.7, 4.0-15), for-profit facility (OR2.7, 1.5-5.0), facility with 100+ beds (OR3.3, 1.8-6.0); to lack living will (OR2.7, 1.2-5.8), and do-not-resuscitate directives (OR6.3, 3.8-10.4). On average, near end of life the outliers were hospitalized for 32.5+2.6SEM (median 24) days. Average charges (mean $122,962, median $81,782) were nearly 6 times higher than for the remaining 1412 hospitalized subjects with lower utilization (mean $22,257, median $12,988). Conclusion: This research suggests a number of characteristics associated with high MSU near end of life among cognitively impaired nursing home residents. Further examination, including multivariable analysis, is needed to identify factors contributing to high end of life MSU.

Learning Objectives:

• Define severe cognitively impaired population of nursing home residents as a model for medical services utilization near end of life
• Examine characteristics associated with high utilization of medical services near end of life

Keywords: End-of-Life Care, Utilization

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation