Site of Death, Place of Care, and Health Care Transitions Among US Medicare Beneficiaries, 2000-2015.
Site of Death, Place of Care, and Health Care Transitions Among US Medicare Beneficiaries, 2000-2015.
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DOI：
10.1001/jama.2018.8981
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发表时间：
2018-07-17
期刊：
影响因子：
--
通讯作者：
Mor V
中科院分区：
文献类型：
--
作者：
Teno JM;Gozalo P;Trivedi AN;Bunker J;Lima J;Ogarek J;Mor V
临终关怀费用很高，死者往往经历护理质量差。许多因素影响死亡地点的变化，医疗保健的转变，以及繁重的护理模式。描述死亡地点和医疗保险死者护理模式的变化。在20%随机抽样的1361870名接受医疗保险服务收费的死者中进行的回顾性队列研究（2000年，2005年，2009年，2011年和2015年）和871845名拥有Medicare Advantage的死者的100%样本（2011年和2015年），并在急性护理医院、家庭或社区、临终关怀住院护理病房或疗养院接受护理。2000年至2015年的长期变化。医疗保险管理数据用于确定死亡地点，护理地点，医疗保健过渡，这是护理地点的变化，以及繁重的护理模式。负担沉重的护理模式是基于生命最后3天内的医疗保健过渡和生命最后120天内因感染或脱水多次住院。研究了1，361，870名享受医疗保险按服务收费的死者（平均[SD]年龄，82.8 [8.4]岁; 58.7%为女性）和871，845名享受医疗保险优势的死者（平均[SD]年龄，82.1 [8.5]岁; 54.0%为女性）的死亡部位和护理模式。在医疗保险按服务收费的死亡者中，在急诊医院发生的死亡比例从32.6%下降到32.6%。（95%置信区间，32.4%-32.8%）（95%CI，19.6%-20.0%），在包括辅助生活设施的家庭或社区环境中死亡的人数从2015年的30.7%增加到2015年的30.7%。（95% CI，30.6%-30.9%）降至2015年的40.1%（95% CI，39.9%-30.3%）。在医疗保险收费服务死者中，在生命的最后30天内使用重症监护室的比例从2000年的24.3%（95% CI，24.1%-24.4%）增加，然后在2009年至2015年期间稳定在29.0%（95% CI，28.8%-29.2%）。在医疗保险收费服务死者中，生命最后3天的医疗保健过渡从2000年的10.3%（95% CI，10.1%-10.4%）增加到2009年的14.2%（95% CI，14.0%-14.3%），然后下降到2015年的10.8%（95% CI，10.6%-10.9%）。在生命的最后90天内参加Medicare Advantage的死者人数从2011年的358，600人增加到2015年的513，245人。在具有医疗保险优势的死者中，观察到死亡地点，护理地点和医疗保健过渡的比率相似。与2000年相比，在2015年死亡的医疗保险按服务收费受益人中，在急性护理医院死亡的可能性较低，在生命的最后一个月，重症监护病房的使用增加然后稳定，在生命的最后3天，医疗保健过渡增加然后下降。
End-of-life care costs are high and decedents often experience poor quality of care. Numerous factors influence changes in site of death, health care transitions, and burdensome patterns of care. To describe changes in site of death and patterns of care among Medicare decedents. Retrospective cohort study among a 20% random sample of 1 361 870 decedents who had Medicare fee-for-service (2000, 2005, 2009, 2011, and 2015) and a 100% sample of 871845 decedents who had Medicare Advantage (2011 and 2015) and received care at an acute care hospital, at home or in the community, at a hospice inpatient care unit, or at a nursing home. Secular changes between 2000 and 2015. Medicare administrative data were used to determine site of death, place of care, health care transitions, which are changes in location of care, and burdensome patterns of care. Burdensome patterns of care were based on health care transitions during the last 3 days of life and multiple hospitalizations for infections or dehydration during the last 120 days of life. The site of death and patterns of care were studied among 1 361 870 decedents who had Medicare fee-for-service (mean [SD] age, 82.8 [8.4] years; 58.7% female) and 871 845 decedents who had Medicare Advantage (mean [SD] age, 82.1 [8.5] years; 54.0% female). Among Medicare fee-for-service decedents, the proportion of deaths that occurred in an acute care hospital decreased from 32.6% (95% CI, 32.4%−32.8%) in 2000 to 19.8% (95% CI, 19.6%−20.0%) in 2015, and deaths in a home or community setting that included assisted living facilities increased from 30.7% (95% CI, 30.6%−30.9%) in 2000 to 40.1% (95% CI, 39.9%−30.3%) in 2015. Use of the intensive care unit during the last 30 days of life among Medicare fee-for-service decedents increased from 24.3% (95% CI, 24.1%−24.4%) in 2000 and then stabilized between 2009 and 2015 at 29.0% (95% CI, 28.8%−29.2%). Among Medicare fee-for-service decedents, health care transitions during the last 3 days of life increased from 10.3% (95% CI, 10.1%−10.4%) in 2000 to a high of 14.2% (95% CI, 14.0%−14.3%) in 2009 and then decreased to 10.8% (95% CI, 10.6%−10.9%) in 2015. The number of decedents enrolled in Medicare Advantage during the last 90 days of life increased from 358 600 in 2011 to 513 245 in 2015. Among decedents with Medicare Advantage, similar patterns in the rates for site of death, place of care, and health care transitions were observed. Among Medicare fee-for-service beneficiaries who died in 2015 compared with 2000, there was a lower likelihood of dying in an acute care hospital, an increase and then stabilization of intensive care unit use during the last month of life, and an increase and then decline in health care transitions during the last 3 days of life.
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影响因子：
120.7
作者：
Teno, Joan M.;Gozalo, Pedro L.;Bynum, Julie P. W.;Leland, Natalie E.;Miller, Susan C.;Morden, Nancy E.;Scupp, Thomas;Goodman, David C.;Mor, Vincent
通讯作者：
Mor, Vincent
影响因子：
3
作者：
Koroukian, Siran M.;Schiltz, Nicholas K.;Berger, Nathan A.
通讯作者：
Berger, Nathan A.
影响因子：
3
作者：
Stevenson DG;Ayanian JZ;Zaslavsky AM;Newhouse JP;Landon BE
通讯作者：
Landon BE
DOI：
10.1111/j.1532-5415.2005.00502.x
发表时间：
2005-12-01
影响因子：
6.3
作者：
Johnson, KS;Kuchibhatala, M;Tulsky, JA
通讯作者：
Tulsky, JA
影响因子：
3.4
作者：
Intrator, Orna;Hiris, Jeffrey;Mor, Vince
通讯作者：
Mor, Vince