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首页> 外文期刊>JAMA: the Journal of the American Medical Association >Association between the medicare hospice benefit and health care utilization and costs for patients with poor-prognosis cancer
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Association between the medicare hospice benefit and health care utilization and costs for patients with poor-prognosis cancer

机译：Medicare临终关怀患者患者的医疗保险临界受益和医疗利用率和成本差

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IMPORTANCE: More patients with cancer use hospice currently than ever before, but there are indications that care intensity outside of hospice is increasing, and length of hospice stay decreasing. Uncertainties regarding how hospice affects health care utilization and costs have hampered efforts to promote it. OBJECTIVE: To compare utilization and costs of health care for patients with poor-prognosis cancers enrolled in hospice vs similar patients without hospice care. DESIGN, SETTING, AND PARTICIPANTS: Matched cohort study of patients in hospice and nonhospice care using a nationally representative 20% sample of Medicare fee-for-service beneficiaries who died in 2011. Patients with poor-prognosis cancers (eg, brain, pancreatic, metastatic malignancies) enrolled in hospice before death were matched to similar patients who died without hospice care. EXPOSURES: Period between hospice enrollment and death for hospice beneficiaries, and the equivalent period of nonhospice care before death for matched nonhospice patients. MAIN OUTCOMES AND MEASURES: Health care utilization including hospitalizations and procedures, place of death, cost trajectories before and after hospice start, and cumulative costs, all during the last year of life. RESULTS: Among 86 851 patients with poor-prognosis cancers, median time from first poor-prognosis diagnosis to death was 13 months (interquartile range [IQR], 3-34), and 51 924 (60%) entered hospice before death. Matching yielded a cohort balanced on age, sex, region, time from poor-prognosis diagnosis to death, and baseline care utilization, with 18 165 patients in the hospice group and 18 165 in the nonhospice group. (Table presented)After matching, 11% of nonhospice and 1% of hospice beneficiaries who had cancer-directed therapy after exposure were excluded. Median hospice duration was 11 days. Nonhospice beneficiaries had significantly greater health care utilization, largely for acute conditions not directly related to cancer and higher overall costs. CONCLUSIONS AND RELEVANCE In this sample of Medicare fee-for-service beneficiaries with poor-prognosis cancer, those receiving hospice care vs not (control), had significantly lower rates of hospitalization, intensive care unit admission, and invasive procedures at the end of life, along with significantly lower total costs during the last year of life.
机译：重要性：更多癌症使用患者，目前比以往任何时候都患者，但有迹象表明，临终关怀之外的护理强度正在增加，临终关怀的长度持续下降。关于临终关怀如何影响医疗保健利用率的不确定性，费用阻碍了促进它的努力。目的：比较医疗疾病患者的医疗保健的利用率和成本，VS类似患者没有临终关怀护理。设计，设定和参与者：使用2011年在2011年死亡的国家代表20％的医疗保险服务受益人样本匹配患者和非医疗保健的群组研究。预后疾病患者（例如，脑，胰腺，在死亡前招待所招待所的转移性恶性肿瘤与没有临终关怀护理的类似患者匹配。暴露：临终关怀受益者的临终关怀和死亡之间的期限，以及匹配的非健身患者死亡前的相当时期的非医疗小心。主要成果和措施：医疗利用包括住院和程序，死亡地点，临终关怀前后的成本轨迹，以及在过去的一年期间的累积成本。结果：在86例851例患有预后疾病疾病的86例患者中，从第一次贫困预后诊断到死亡的中位数是13个月（四分位数范围[IQR]，3-34）和51 924（60％）在死亡之前进入临终关怀。匹配在年龄，性别，地区，从预后诊断到死亡差和基线护理利用率的时间均衡，以及18名165名患者在临终关怀组和非健身组织中的18岁165名。 （表呈现）在匹配后，排除了11％的非健身手术和1％的临终关怀受益者，被排除在暴露后进行癌症治疗。中位临终关系持续时间为11天。非医疗利益受益人的医疗利用率明显更大，主要是与癌症直接相关的急性条件和更高的总成本。结论和相关性在这种医疗保险费用受益人样本中，具有贫恶癌症，接受临终关怀护理VS（控制），住院治疗率明显降低了生命结束时的住院治疗，重症监护病房录取和侵入性手术以及在去年生命的总成本下显着降低。

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    ObermeyerZ.; MakarM.; AbujaberS.; DominiciF.; BlockS.; CutlerD.M.;

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    Departments of Emergency Medicine and Health Care Policy Harvard Medical SchoolBoston MA United;

    Department of Emergency Medicine Brigham and Women's Hospital Neville House 75 Francis StBoston;

    Department of Emergency Medicine Brigham and Women's Hospital Neville House 75 Francis StBoston;

    Department of Biostatistics Harvard School of Public HealthBoston MA United States;

    Ariadne Labs Brigham and Women's Hospital Harvard School of Public HealthBoston MA United;

    Department of Economics Harvard UniversityCambridge MA United States National Bureau of;

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  • 正文语种 eng
  • 中图分类 医药、卫生;
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