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Resource use in the last 6 months of life among medicare beneficiaries with heart failure, 2000-2007.

Publication ,  Journal Article
Unroe, KT; Greiner, MA; Hernandez, AF; Whellan, DJ; Kaul, P; Schulman, KA; Peterson, ED; Curtis, LH
Published in: Arch Intern Med
February 14, 2011

BACKGROUND: Heart failure is a common cause of death among Medicare beneficiaries, but little is known about health care resource use at the end of life. METHODS: In a retrospective cohort study of 229,543 Medicare beneficiaries with heart failure who died between January 1, 2000, and December 31, 2007, we examined resource use in the last 180 days of life, including all-cause hospitalizations, intensive care unit days, skilled nursing facility stays, home health, hospice, durable medical equipment, outpatient physician visits, and cardiac procedures. We calculated overall costs to Medicare and predictors of costs. RESULTS: Approximately 80% of patients were hospitalized in the last 6 months of life; days in intensive care increased from 3.5 to 4.6 (P<.001). Use of hospice increased from 19% to nearly 40% of patients (P<.001). Unadjusted mean costs to Medicare per patient rose 26% from $28,766 to $36,216 (P<.001). After adjustment for age, sex, race, comorbid conditions, and geographic region, costs increased by 11% (cost ratio, 1.11; 95% confidence interval, 1.10-1.13). Increasing age was strongly and independently associated with lower costs. Renal disease, chronic obstructive pulmonary disease, and black race were independent predictors of higher costs. CONCLUSIONS: Among Medicare beneficiaries with heart failure, health care resource use at the end of life increased over time with higher rates of intensive care and higher costs. However, the use of hospice services also increased markedly, representing a shift in patterns of care at the end of life.

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Published In

Arch Intern Med

DOI

EISSN

1538-3679

Publication Date

February 14, 2011

Volume

171

Issue

3

Start / End Page

196 / 203

Location

United States

Related Subject Headings

  • Utilization Review
  • United States
  • Terminal Care
  • Retrospective Studies
  • Practice Guidelines as Topic
  • Patient Admission
  • Palliative Care
  • Medicare
  • Male
  • Length of Stay
 

Citation

APA
Chicago
ICMJE
MLA
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Unroe, K. T., Greiner, M. A., Hernandez, A. F., Whellan, D. J., Kaul, P., Schulman, K. A., … Curtis, L. H. (2011). Resource use in the last 6 months of life among medicare beneficiaries with heart failure, 2000-2007. Arch Intern Med, 171(3), 196–203. https://doi.org/10.1001/archinternmed.2010.371
Unroe, Kathleen T., Melissa A. Greiner, Adrian F. Hernandez, David J. Whellan, Padma Kaul, Kevin A. Schulman, Eric D. Peterson, and Lesley H. Curtis. “Resource use in the last 6 months of life among medicare beneficiaries with heart failure, 2000-2007.Arch Intern Med 171, no. 3 (February 14, 2011): 196–203. https://doi.org/10.1001/archinternmed.2010.371.
Unroe KT, Greiner MA, Hernandez AF, Whellan DJ, Kaul P, Schulman KA, et al. Resource use in the last 6 months of life among medicare beneficiaries with heart failure, 2000-2007. Arch Intern Med. 2011 Feb 14;171(3):196–203.
Unroe, Kathleen T., et al. “Resource use in the last 6 months of life among medicare beneficiaries with heart failure, 2000-2007.Arch Intern Med, vol. 171, no. 3, Feb. 2011, pp. 196–203. Pubmed, doi:10.1001/archinternmed.2010.371.
Unroe KT, Greiner MA, Hernandez AF, Whellan DJ, Kaul P, Schulman KA, Peterson ED, Curtis LH. Resource use in the last 6 months of life among medicare beneficiaries with heart failure, 2000-2007. Arch Intern Med. 2011 Feb 14;171(3):196–203.

Published In

Arch Intern Med

DOI

EISSN

1538-3679

Publication Date

February 14, 2011

Volume

171

Issue

3

Start / End Page

196 / 203

Location

United States

Related Subject Headings

  • Utilization Review
  • United States
  • Terminal Care
  • Retrospective Studies
  • Practice Guidelines as Topic
  • Patient Admission
  • Palliative Care
  • Medicare
  • Male
  • Length of Stay