期刊
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
卷 309, 期 5, 页码 470-477出版社
AMER MEDICAL ASSOC
DOI: 10.1001/jama.2012.207624
关键词
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资金
- National Institutes of Health
- Center for Gerontology and Healthcare Research of Brown University
- AmericanOccupational Therapy Association
- Robert Wood Johnson Foundation
- World Congress
- Illinois Hospital Association
- National Hospice Workgroup
- National Association of Health Data Organizations
- St Peters University Hospital
- Massachusetts Hospital Association
- Cooper Health System
- Organizzato dal Laboratoria Management e Sanit a Scuola Superiore Sant'Anna di Pisa
- Kentucky Academy of Family Physicians
- Southern Illinois University Health Policy Institute
- Ohio University College of Osteopathic Medicine
- Institute for Clinical Quality and Value
- Marwood Group
- American Society of Clinical Oncologists
- Delta Health Alliance
- SUNY Upstate University
- Intermountain Healthcare
- Canadian Health Services Research Foundation
- Massachusetts Health Data Consortium
- Organisation for Economic Cooperation and Development
Importance A recent Centers for Disease Control and Prevention report found that more persons die at home. This has been cited as evidence that persons dying in the United States are using more supportive care. Objective To describe changes in site of death, place of care, and health care transitions between 2000, 2005, and 2009. Design, Setting, and Patients Retrospective cohort study of a random 20% sample of fee-for-service Medicare beneficiaries, aged 66 years and older, who died in 2000 (n=270 202), 2005 (n=291 819), or 2009 (n=286 282). A multivariable regression model examined outcomes in 2000 and 2009 after adjustment for sociodemographic characteristics. Based on billing data, patients were classified as having a medical diagnosis of cancer, chronic obstructive pulmonary disease, or dementia in the last 180 days of life. Main Outcome Measures Site of death, place of care, rates of health care transitions, and potentially burdensome transitions (eg, health care transitions in the last 3 days of life). Results Comparing 2000, 2005, and 2009 shows a decrease in deaths in acute care hospitals and increases in intensive care unit (ICU) use in the last 30 days, hospice use at the time of death, and health care transitions at the end of the life (test of trend P < .001 for each). [GRAPHICS] In 2009, 28.4% (95% CI, 27.9%-28.5%) of hospice use at the time of death was for 3 days or less. Of these late hospice referrals, 40.3% (95% CI, 39.7%-40.8%) were preceded by hospitalization with an ICU stay. Conclusion and Relevance Among Medicare beneficiaries who died in 2009 and 2005 compared with 2000, a lower proportion died in an acute care hospital, although both ICU use and the rate of health care transitions increased in the last month of life. JAMA. 2013; 309(5): 470-477 www.jama.
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