Service use at the end-of-life in Medicare advantage versus traditional Medicare.
Service use at the end-of-life in Medicare advantage versus traditional Medicare.
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DOI：
10.1097/mlr.0b013e3182a50278
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发表时间：
2013-10
期刊：
影响因子：
3
通讯作者：
Landon BE
中科院分区：
文献类型：
--
作者：
Stevenson DG;Ayanian JZ;Zaslavsky AM;Newhouse JP;Landon BE
相对于传统的按服务收费的医疗保险，管理式医疗计划照顾医疗保险受益人可能更好地定位于促进推荐服务，并阻止在生命结束时几乎没有临床价值的繁琐程序。比较医疗保险优势健康维护组织（MA-HMO）参保者与传统医疗保险（TM）参保者的临终服务使用情况。对于2003-2009年死亡年份持续在MA-HMO或TM登记的医疗保险死者的国家队列，我们获得临终关怀登记信息和个人水平医疗保健有效性数据和信息集（HEDIS®）在死亡前一年的MA-HMO死者的利用措施。我们针对年龄、性别、种族和地点匹配的TM死者制定了可比较的基于索赔的措施。2003年，MA患者在死亡前一年接受临终关怀的比例高于TM患者（38% vs. 29%），但在研究期间，这一差距缩小了（46% vs. 2009年的40%）。与TM相比，MA患者的住院率（5-14%）、住院天数（18-29%）和急诊科就诊率（42-54%）显著降低。到2009年，MA患者的门诊手术率较低，与TM率趋同；到2007年，MA患者的医生就诊率略低，超过TM率。相对于同一地区类似的TM死者，MA- hmo的死者更频繁地参加临终关怀，使用较少的住院和急诊服务，表明MA计划在医院环境中提供较少的临终关怀。
Relative to traditional fee-for-service Medicare, managed care plans caring for Medicare beneficiaries may be better positioned to promote recommended services and discourage burdensome procedures with little clinical value at the end of life. To compare end-of-life service use for enrollees in Medicare Advantage health maintenance organizations (MA-HMO) relative to similar individuals enrolled in traditional Medicare (TM). For a national cohort of Medicare decedents continuously enrolled in MA-HMOs or TM in their year of death, 2003-2009, we obtained hospice enrollment information and individual-level Healthcare Effectiveness Data and Information Set (HEDIS®) utilization measures for MA-HMO decedents for up to one year prior to death. We developed comparable claims-based measures for TM decedents matched on age, sex, race, and location. Hospice use in the year preceding death was higher among MA than TM decedents in 2003 (38% vs. 29%), but the gap narrowed over the study period (46% vs. 40% in 2009). Relative to TM, MA decedents had significantly lower rates of inpatient admissions (5-14% lower), inpatient days (18-29%), and emergency department visits (42-54%). MA decedents initially had lower rates of ambulatory surgery and procedures that converged with TM rates by 2009 and had modestly lower rates of physician visits initially that surpassed TM rates by 2007. Relative to comparable TM decedents in the same local areas, MA-HMO decedents more frequently enrolled in hospice and used fewer inpatient and emergency department services, demonstrating that MA plans provide less end-of-life care in hospital settings.