Variation in Intensity and Costs of Care by Payer and Race for Patients Dying of Cancer in Texas: An Analysis of Registry-linked Medicaid, Medicare, and Dually Eligible Claims Data.
Variation in Intensity and Costs of Care by Payer and Race for Patients Dying of Cancer in Texas: An Analysis of Registry-linked Medicaid, Medicare, and Dually Eligible Claims Data.
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DOI：
10.1097/mlr.0000000000000369
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发表时间：
2015-07
期刊：
影响因子：
3
通讯作者：
Shih YC
中科院分区：
文献类型：
--
作者：
Guadagnolo BA;Liao KP;Giordano SH;Elting LS;Shih YC
调查在德克萨斯州死于癌症的医疗补助、医疗保险和双重资格受益人的临终关怀。我们分析了德克萨斯州癌症登记处（TCR）-医疗补助和TCR-Medicare链接数据库的索赔数据，这些数据来自2000年至2008年德克萨斯州69，572名死于癌症的患者。我们对生命最后30天的癌症导向和急性护理以及护理总成本（以2014年美元计）进行了调整分析。医疗补助患者更有可能接受化疗和放疗。与医疗保险患者相比，医疗补助患者更有可能拥有>1个急诊室（ER）（OR=5.27，95% CI：4.76-5.84），并且不太可能参加临终关怀（OR=0.59，95% CI：0.55-0.63）。双重死亡者比仅医疗保险受益人更可能有>1次ER就诊（OR=1.19，95%CI：1.07-1.33）。黑人和西班牙裔患者比白人更可能经历> 1次ER就诊和>1次住院。与白色医疗保险登记者相比，非白色医疗保险、医疗补助和双重资格患者的费用更高。不同种族和支付者的急性护理利用率和成本的变化表明，需要努力解决医疗补助和双重资格受益人以及少数死于癌症的患者在生命结束时的姑息治疗协调问题。
To investigate end-of-life care for Medicaid, Medicare, and dually eligible beneficiaries dying of cancer in Texas. We analyzed the Texas Cancer Registry (TCR)-Medicaid and TCR-Medicare linked databases’ claims data for 69,572 patients dying of cancer in Texas from 2000–2008. We conducted regression models in adjusted analyses of cancer-directed and acute care and total costs of care (in 2014 dollars) in the last 30 days of life. Medicaid patients were more likely to receive chemotherapy and radiation therapy. Medicaid patients were more likely to have >1 emergency room (ER) (OR=5.27, 95% CI: 4.76–5.84), and were less likely to enroll in hospice (OR=0.59, 95% CI: 0.55–0.63) than Medicare patients. Dual eligibles were more likely to have >1 ER visit than Medicare-only beneficiaries (OR=1.19, 95% CI: 1.07–1.33). Black and Hispanic patients were more likely to experience > 1 ER visit and >1 hospitalization than whites. Costs were higher for non-white Medicare , Medicaid, and dually eligible patients compared to white Medicare enrollees. Variation in acute care utilization and costs by race and payer suggest efforts are needed to address palliative care coordination at the end of life for Medicaid and dually eligible beneficiaries and minority patients dying of cancer.