Are regional variations in end-of-life care intensity explained by patient preferences? A study of the US medicare population

被引:330
作者
Barnato, Amber E.
Herndon, M. Brooke
Anthony, Denise L.
Gallagher, Patricia M.
Skinner, Jonathan S.
Bynum, Julie P. W.
Fisher, Elliott S.
机构
[1] Univ Pittsburgh, Ctr Res Hlth Care, Pittsburgh, PA 15312 USA
[2] Dartmouth Hitchcocok Med Ctr, Lebanon, NH USA
[3] Dartmouth Coll, Dept Sociol, Hanover, NH USA
[4] Univ Massachusetts, Ctr Survey Res, Boston, MA 02125 USA
[5] Dartmouth Coll Sch Med, Ctr Evaluat Clin Sci, Hanover, NH USA
关键词
medicare; health care costs; physician's practice patterns; terminal care; patient satisfaction; SUPPLIER-INDUCED DEMAND; NEW-HAVEN; PHYSICIANS; BENEFICIARIES; UNCERTAINTY; SERVICES; OUTCOMES; QUALITY; BOSTON;
D O I
10.1097/01.mlr.0000255248.79308.41
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Objective: We sought to test whether variations across regions in end-of-life (EOL) treatment intensity are associated with regional differences in patient preferences for EOL care. Research Design: Dual-language (English/Spanish) survey conducted March to October 2005, either by mail or computer-assisted telephone questionnaire, among a probability sample of 3480 Medicare part A and/or B eligible beneficiaries in the 20% denominator file, age 65 or older on July 1, 2003. Data collected included demographics, health status, and general preferences for medical care in the event the respondent had a serious illness and less than 1 year to live. EOL concerns and preferences were regressed on hospital referral region EOL spending, a validated measure of treatment intensity. Results: A total of 2515 Medicare beneficiaries completed the survey (65% response rate). In analyses adjusted for age, sex, race/ethnicity, education, financial strain, and health status, there were no differences by spending in concern about getting too little treatment (39.6% in lowest spending quintile, Q1; 41.2% in highest, Q5; P value for trend, 0.637) or too much treatment (44.2% Q1, 45.1% Q5; P = 0.797) at the end of life, preference for spending their last days in a hospital (8.4% Q1, 8.5% Q5; P = 0.965), for potentially life-prolonging drugs that made them feel worse all the time (14.4% Q1, 16.5% Q5; P = 0.326), for palliative drugs, even if they might be life-shortening (77.7% Q1, 73.4% Q5; P = 0.138), for mechanical ventilation if it would extend their life by 1 month Conclusions: Medicare beneficiaries generally prefer treatment focused on palliation rather than life-extension. Differences in preferences are unlikely to explain regional variations in EOL spending.
引用
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页码:386 / 393
页数:8
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