Patient Experiences of Medicare Beneficiaries near the End-of-Life

Research based primarily on retrospective reports from surviving relatives shortly after a patient's death often suggests that end-of-life care provides poor patient experiences. However, such findings may be influenced by knowledge of the outcome, be subject to recall bias, and capture only the last month of life. We compared patient-reported experiences of care near the end-of-life to other care, using a large national survey of Medicare beneficiaries (n=402,593). By linking survey completion dates to Social Security Administration death records, we identified beneficiaries who died within a year of completing the Medicare Advantage (MA) CAHPS Survey. We then compared 10 CAHPS patient experience measures between those who would die within one year (the “near-end-of-life” group) to those who were alive one year later using propensity-score weighting to account for selection plus regression-based case-mix adjustment. Models adjusted for health status, location, and sociodemographic characteristics.

12,227 beneficiaries died within a year of completing the survey (3%). There were no measures for which the near-end-of-life group reported worse experiences than other matched beneficiaries. In contrast, near-end-of-life beneficiaries reported better experiences than other beneficiaries with respect to Getting Care Quickly (p<0.0001) and provided higher ratings for their plans (p<0.0001) and prescription drug coverage (p=0.02).

These findings suggest that, contrary to previous proxy retrospective reports about care in the last weeks of life, the near-end-of-life patient experiences of Medicare beneficiaries may be as positive or more positive than those under other circumstances, especially with respect to prompt care.