Qualitative Analysis of Medicare Claims in the Last 3 Years of Life: A Pilot Study

Barnato, Amber E.; Labor, Renee; Freeborne, Nancy; Jayes, Robert L.; Campbell, Diane E.; Lynn, Joanne

doi:10.1111/j.1532-5415.2005.53012.x

Cited by 7 publications

(4 citation statements)

References 20 publications

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“…Guaranteeing comprehensive integrated care allows patients to receive relief of physical (pain, shortness of breath, nausea, etc.) and psychological (fear, anxiety, concerns) symptoms, and to have their spiritual and social needs met (Barnato et al., ; Hall, Weaver, Gravelle, & Thibault, ). Hence, the integrated multidisciplinary team fosters adequate treatment of patients’ complex needs (Brazil et al., ; Lorenz et al., ; Wiebe & Von Roenn, ).…”

Section: Resultsmentioning

confidence: 99%

Continuity of Care During End of Life: An Evolutionary Concept Analysis

D’Angelo

Mastroianni

Hammer

et al. 2014

Int J of Nursing Knowl

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PURPOSE: The purpose of this study was to clarify the concept of continuity of\ud care during the end of life with a focus on the patient’s perspective.\ud METHODS: Rodgers’ method of evolutionary concept analysis was used. The\ud analysis was based on literature published in English in the databases Cumulative\ud Index for Nursing and Allied Health Literature, Medline, and PsycINFO.\ud FINDINGS: Analysis revealed that the continuity at life’s end is a dynamic process\ud that depends on the interaction among patients, families, and providers, and is\ud strictly interwoven with the patient’s time perception.\ud CONCLUSION: This analysis showed the complexities surrounding the patient’s\ud experience of continuity at life’s end.\ud IMPLICATION FOR NURSING: Nurses can benefit from a deeper understanding\ud of the patient’s experience, both theoretically and in practice

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Section: Resultsmentioning

confidence: 99%

Continuity of Care During End of Life: An Evolutionary Concept Analysis

D’Angelo

Mastroianni

Hammer

et al. 2014

Int J of Nursing Knowl

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“…In this study, a claims‐based approach to classifying health of Medicare decedents was modified and applied to the year before a critical illness. Previous work on the classification of Medicare decedents motivated the health classification scheme, and an extensive review of the geriatric literature to include such multifactorial geriatric conditions as debility, accidental falls, fractures, malnutrition and weight loss, and pressure ulcers, which have all been associated with disability and poor quality of life in elderly adults, supplemented the definition of frailty . The face validity of this approach is reflected in the fact that participants with pre‐ICU frailty were older, more likely to be female, and less likely to be admitted to the ICU for surgical treatment, consistent with much of the literature .…”

Section: Discussionmentioning

confidence: 99%

“…All Medicare claims from the four quarters before the index hospitalization were used to provide information on previously existing conditions using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) diagnosis codes. A descriptive classification scheme developed for Medicare decedents was modified and used to group participants into four pre‐ICU health categories using ICD‐9 diagnoses and specific facility claims (Supporting information, Table S1) . Participants with one or more claims with a diagnosis of cancer (excluding benign neoplasm, carcinoma insitu, or malignancies labeled as “unspecified nature”) were classified in the cancer group.…”

Section: Methodsmentioning

confidence: 99%

“…A descriptive classification scheme developed for Medicare decedents was modified and used to group participants into four pre-ICU health categories using ICD-9 diagnoses and specific facility claims (Supporting information, Table S1). 5,6,14 Participants with one or more claims with a diagnosis of cancer (excluding benign neoplasm, carcinoma insitu, or malignancies labeled as "unspecified nature") were classified in the cancer group. Participants who had a diagnosis of congestive heart failure, ischemic heart disease, chronic liver disease, or chronic obstructive pulmonary disease (excluding individuals with a diagnosis of acute bronchitis) were classified in the chronic organ failure group.…”

Section: Defining Health Categories Before Admission To An Icumentioning

confidence: 99%

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Frailty Before Critical Illness and Mortality for Elderly Medicare Beneficiaries

Hope

Gong

Guerra

et al. 2015

J American Geriatrics Society

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Background Health categories of elderly patients prior to critical illness may explain differences in mortality during and after admission to intensive care units (ICUs). Objectives To estimate the effect of pre-ICU health categories on mortality during and after critical illness, focusing specifically on the effect of pre-ICU frailty on short- and long-term mortality. Design Retrospective cohort study using linked Medicare claims data from 2004–2008. Participants A nationally representative sample of elderly Medicare beneficiaries who were admitted to an ICU in 2005. Measurements Patients were classified into four pre-ICU health categories (Robust; Cancer; Chronic Organ Failure; Frailty) using claims data from the year prior to admission, allowing for assignment to multiple categories. We assessed the association between pre-ICU health categories and hospital and 3-year mortality using multivariable logistic regression and Cox proportional Hazards models. Results Among 47,427 elderly ICU patients, 18.8% were Robust; 28.6% had pre-ICU Cancer; 68.1% Chronic Organ Failure and 34.0% Frailty; 41.3% qualified for multiple categories. Overall hospital mortality was 12.6%, with the lowest mortality for Robust patients (9.7%). Patients with pre-ICU Frailty had a higher hospital mortality compared to patients with the same pre-ICU health categories without frailty (adjusted Odds Ratios ranged from 1.27 (95% confidence interval (CI) 1.10–1.47) to 1.52 (95% CI 1.35–1.63)). Robust hospital survivors had the lowest 3-year mortality (24.6%). Pre-ICU Frailty conferred a higher 3-year mortality compared to pre-ICU categories without frailty (adjusted Hazard Ratios ranged from 1.54 (95% CI 1.45–1.64) to 1.84 (95% CI 1.70–1.99). Conclusion Critically ill elderly patients can be categorized by Pre-ICU health categories. These categories, particularly pre-ICU Frailty, may be important for understanding risk of death during and after critical illness.

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Resurrecting Treatment Histories of Dead Patients

2005

JAMA

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Qualitative Analysis of Medicare Claims in the Last 3 Years of Life: A Pilot Study

Cited by 7 publications

References 20 publications

Continuity of Care During End of Life: An Evolutionary Concept Analysis

Continuity of Care During End of Life: An Evolutionary Concept Analysis

Frailty Before Critical Illness and Mortality for Elderly Medicare Beneficiaries

Resurrecting Treatment Histories of Dead Patients

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