End of Life Care

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Data Source

Atlas Data – Supplemental Research Data
(under “Longitudinal Research Files – End-of-life inpatient care (all decedents)”)

The intensity of care in the last six months of life is an indicator of the propensity to use life-saving technology. The question of whether more medical intervention is better must be framed in terms of the potential gain in life expectancy for populations living in regions with greater intensity of intervention. Our research has provided evidence that populations living in regions with lower intensity of care in the last six months of life did not have higher mortality rates than those living in regions with higher care intensity.

More than 80% of patients say that they wish to avoid hospitalization and intensive care during the terminal phase of illness, but those wishes are often overridden by other factors. If more intense intervention does not improve life expectancy, and if most patients prefer less care when more intensive care is likely to be futile, the fundamental question is whether the quality of care in regions with fewer resources and more conservative practice styles is better than in regions where more aggressive treatment is the norm.

For rates pertaining to the last six months of life, the denominator was the Medicare population who died during the measurement year. Numerator events were determined using the Medicare Provider Analysis and Review (MedPAR) file. Rates for inpatient care per capita were computed using only the portion of the event (hospital stay or ICU stay) falling within the six-month period prior to death. Rates were age, sex and race adjusted using the indirect method.

End of Life Care – by HRR

More information on Hospital Referral Regions (HRR)

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End of Life Care – by HSA

More information on Hospital Service Areas (HSA)

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End of Life Care – by State


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End of Life Care – by County


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Denominator Definition
100% of Medicare enrollees age 65-99 who died during the measurement year with full Part A entitlement and no HMO enrollment during the measurement period. Age, gender, race, and eligibility are determined using the Denominator file.

Numerator Definition
Hospital Admissions per Decedent During the Last Six Months of Life
Any admission within six months of the death date in the MedPAR file. ICU admission is determined by the presence of an ICU day indicator in the MedPAR claim: ICARECNT (intensive care day count), CRNRYDAY (coronary care day count).

ICU/CCU Admissions
Number of patients admitted to ICU or CCU during terminal hospitalization (discharge status=’B’ in MedPAR file). ICU admission is determined by the presence of an ICU day indicator in the MedPAR claim: ICARECNT (intensive care day count), CRNRYDAY (coronary care day count).

ICU/CCU Allowed Charges
Number of patients spending 7 or more days in ICU within six months of the death date in the MedPAR file. For stays that began prior to the six-month period before the death date, only the portion of the event that occurred within the six-month window is used. ICU days are determined by the following indicators in the MedPAR claim: ICARECNT (intensive care day count), CRNRYDAY (coronary care day count).

Inpatient Days
Any inpatient days within six months of the death date in the MedPAR file. For stays that began prior to the six-month period before the death date, only the portion of the event that occurred within the six-month window is used. ICU days are determined by the following indicators in the MedPAR claim: ICARECNT (intensive care day count), CRNRYDAY (coronary care day count).

Inpatient Spending
Inpatient reimbursements ($) within six months of the death date in the MedPAR file. For stays that began prior to the six-month period before the death date, only the portion of the event that occurred within the six-month window is used. ICU spending represents Medicare allowed charges, rather than reimbursements. ICU charges are determined by the following indicators in the MedPAR claim: ICAREAMT (intensive care charge amount), CRNRYAMT (coronary care charge amount).

Percent of Deaths
Number of deaths occurring in a hospital (discharge status=’B’ in MedPAR file).

Percent of Hospital Hospitalizations
Number of enrollees with one or more hospital admissions within six months of the death date in the MedPAR file. ICU admission is determined by the presence of an ICU day indicator in the MedPAR claim: ICARECNT (intensive care day count), CRNRYDAY (coronary care day count).

Adjustments
Rates are adjusted for age, sex and race using the indirect method, using the U.S. Medicare decedent population as the standard. Gender-specific rates are age and race adjusted; race-specific rates are age and sex adjusted.