Health System and Beneficiary Costs Associated With Intensive End-of-Life Medical Services

Gidwani, Risha; Asch, Steven M.; Mor, Vincent; Faricy-Anderson, Katherine E.; Illarmo, Samantha; Hsin, Gary; Patel, Manali I.; Ramchandran, Kavitha; Lorenz, Karl; Needleman, Jack

doi:10.1001/jamanetworkopen.2019.12161

Cited by 16 publications

(14 citation statements)

References 56 publications

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“…[3][4][5][6][7][8] Despite best practice guidelines from the American Society of Clinical Oncology and the National Quality Forum that discourage low-value end-of-life care, many patients with metastatic cancer continue to receive aggressive medical interventions throughout their final weeks of life. 9 Patients with advanced cancer often experience a substantial worsening in health during their final months, occasioning inpatient admission and intensive procedures that add to the substantial emotional and financial burden of care during the final stages of illness 4,[10][11][12] ; yet, this intensive inpatient care often does not achieve end-of-life goals for patients and their families or caregivers. 13,14 Furthermore, previous studies have reported higher rates of invasive end-of-life interventions and higher costs incurred among racial or ethnic minority individuals and patients with low socioeconomic status.…”

Section: Introductionmentioning

confidence: 99%

Disparities in Care Management During Terminal Hospitalization Among Adults With Metastatic Cancer From 2010 to 2017

et al. 2021

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Key Points Question Is variation in care management during terminal hospitalization among adults with metastatic cancer associated with sociodemographic status? Findings In this cross-sectional study of 21 335 patients with metastatic cancer who died in the hospital, racial and ethnic minority patients and those with Medicare or Medicaid coverage were more likely to receive low-value, high-cost aggressive medical interventions at the end of life. Meaning This study’s findings suggest that identifying and understanding factors associated with the observed disparities will be helpful to inform communications with patients with metastatic cancer about end-of-life care.

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Section: Introductionmentioning

confidence: 99%

Disparities in Care Management During Terminal Hospitalization Among Adults With Metastatic Cancer From 2010 to 2017

et al. 2021

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“…Obermeyer et al, 12 using an extensive retrospective Medicare database, showed increased costs in the last month of life for patients with poor prognosis cancer. Gidwani-Marszowshi et al, 13 in a 98% male Veterans Administration database, demonstrated that costs with HC were substantially lower and associated with much less aggressive care than NOHC. Chastek et al, 14 in a commercially insured population, reported similar cost findings.…”

Section: Discussionmentioning

confidence: 99%

Hospice or Hospital: The Costs of Dying of Cancer in the Oncology Care Model

Hoverman

Mann

Phu

et al. 2020

Palliative Medicine Reports

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Background: End-of-life management is a difficult aspect of cancer care. With the oncology care model (OCM), we have data to assess both clinical outcomes and total cost of care (TCOC). Objective: To measure and characterize the TCOC for those who received less than three days of hospice care (HC) at the end of life compared with those who received three days or more. Design: Assess data on costs and site and date of death from Medicare claims on patients identified in the OCM who received chemotherapy in the six months before death. Standard statistical methods were used to characterize both populations. Setting/Subjects: Subjects were Medicare patients with cancer who died while managed by U.S. oncology practices in the OCM. Measurements were TCOC in 30-day intervals for the last months of life, cost by site of care at the end of life, and demographic characteristics of the population and association with HC. Results: There were 7329 deaths. Dying in the hospital was twice the cost of dying at home under HC ($20,113 vs. $10,803). Of demographic groups measured, only black race and a lymphoma diagnosis had <50% hospice enrollment for three days or more before death. Conclusions: This study reinforces previous studies regarding costs in the last 30 days of life. The graphic representation highlights the dollar cost and the costs of lost opportunity. Using these data to improve communication, addressing socioeconomic support, and formal palliative care integration are potential strategies to improve care.

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“…The value of palliative care lies in its ability to raise the quality of life and lower the cost of treatment. In addition, palliative care services also reduce the mean hospitalization duration and cost [ 5 , 7 , 8 ]. It has also been suggested by the American Society of Clinical Oncology and the Institute of Medicine that patients should not receive intensive treatment at the end of their lives [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…It has also been suggested by the American Society of Clinical Oncology and the Institute of Medicine that patients should not receive intensive treatment at the end of their lives [ 7 ]. However, many patients with late-stage cancer still undergo intensive treatments up to a month before their death [ 8 ]. These increase the healthcare costs not only of patients but also of the medical system.…”

Section: Introductionmentioning

confidence: 99%

Exploratory Study of Palliative Care Utilization and Medical Expense for Inpatients at the End-of-Life

Lin

Liu

Huang

et al. 2022

IJERPH

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Background: Previous research mostly analyzed the utilization of palliative care for patients with cancer, and data regarding non-cancer inpatients are limited. Objectives: This research aimed to investigate the current situation regarding palliative care and the important factors that influence its utilization by inpatients (including inpatients with and without cancer) at the end of their lives. We also explored the feasibility of establishing a prediction model of palliative care utilization for inpatients at the end of their lives. These findings will allow medical staff to monitor and focus on those who may require palliative care, resulting in more end-of-life patients receiving palliative care and thereby reducing medical expense and improving their quality of life. Methods: This was a retrospective study based on real-world health information system (HIS) data from 5 different branches of Taipei City Hospital between 1 January 2018 and 31 December 2018 that enrolled a total of 1668 deceased inpatients. To explore palliative care utilization at the end of life, we used 5-fold cross-validation in four different statistical models to obtain the performance of predictive accuracy: logistic regression (LGR), classification and regression tree (CART), multivariate adaptive regression spline (MARS), and gradient boosting (GB). The important variables that may affect palliative care utilization by inpatients were also identified. Results: The results were as follows: (1) 497 (29.8%) inpatients received palliative care; (2) the average daily hospitalization cost of patients with cancer who received palliative care (NTD 5789 vs. NTD 12,115; p ≤ 0.001) and all patients who received palliative care (NTD 91,527 vs. NTD 186,981; p = 0.0037) were statistically significantly lower than patients who did not receive palliative care; (3) diagnosis, hospital, and length of stay (LOS) may affect palliative care utilization of inpatient; diagnosis, hospitalization unit, and length of hospitalization were statistically significant by LGR; (4) 51.5% of patients utilized palliative consultation services, and 48.5% utilized palliative care units; and (5) MARS had the most consistent results; its accuracy was 0.751, and the main predictors of palliative care utilization are hospital, medical expense, LOS, diagnosis, and Palliative Care Screening Tool-Taiwan version (TW-PCST) scores. Conclusions: The results reveal that palliative care utilization by inpatients remains low, and it is necessary to educate patients without cancer of the benefits and advantages of palliative care. Although data were limited, the predictability of the MARS model was 0.751; a better prediction model with more data is necessary for further research. Precisely predicting the need for palliative care may encourage patients and their family members to consider palliative care, which may balance both physical and mental care. Therefore, unnecessary medical care can be avoided and limited medical resources can be allocated to more patients in need.

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Health System and Beneficiary Costs Associated With Intensive End-of-Life Medical Services

Cited by 16 publications

References 56 publications

Disparities in Care Management During Terminal Hospitalization Among Adults With Metastatic Cancer From 2010 to 2017

Disparities in Care Management During Terminal Hospitalization Among Adults With Metastatic Cancer From 2010 to 2017

Hospice or Hospital: The Costs of Dying of Cancer in the Oncology Care Model

Exploratory Study of Palliative Care Utilization and Medical Expense for Inpatients at the End-of-Life

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