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Trends in health care utilization, cost, and aggressive care at end of life among older cancer patients in the Deep South.
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| Zeitschriftentitel: | Journal of Clinical Oncology |
|---|---|
| Personen und Körperschaften: | , , , , , , , , , , , , |
| In: | Journal of Clinical Oncology, 33, 2015, 29_suppl, S. 155-155 |
| Format: | E-Article |
| Sprache: | Englisch |
| veröffentlicht: |
American Society of Clinical Oncology (ASCO)
|
| Schlagwörter: |
| author_facet |
Kvale, Elizabeth Ann Rocque, Gabrielle Bevis, Kerri S. Acemgil, Aras Taylor, Richard A. Demark-Wahnefried, Wendy Kenzik, Kelly Li, Yufeng Meneses, Karen Martin, Michelle Fouad, Mona N. Pisu, Maria Partridge, Edward E. Kvale, Elizabeth Ann Rocque, Gabrielle Bevis, Kerri S. Acemgil, Aras Taylor, Richard A. Demark-Wahnefried, Wendy Kenzik, Kelly Li, Yufeng Meneses, Karen Martin, Michelle Fouad, Mona N. Pisu, Maria Partridge, Edward E. |
|---|---|
| author |
Kvale, Elizabeth Ann Rocque, Gabrielle Bevis, Kerri S. Acemgil, Aras Taylor, Richard A. Demark-Wahnefried, Wendy Kenzik, Kelly Li, Yufeng Meneses, Karen Martin, Michelle Fouad, Mona N. Pisu, Maria Partridge, Edward E. |
| spellingShingle |
Kvale, Elizabeth Ann Rocque, Gabrielle Bevis, Kerri S. Acemgil, Aras Taylor, Richard A. Demark-Wahnefried, Wendy Kenzik, Kelly Li, Yufeng Meneses, Karen Martin, Michelle Fouad, Mona N. Pisu, Maria Partridge, Edward E. Journal of Clinical Oncology Trends in health care utilization, cost, and aggressive care at end of life among older cancer patients in the Deep South. Cancer Research Oncology |
| author_sort |
kvale, elizabeth ann |
| spelling |
Kvale, Elizabeth Ann Rocque, Gabrielle Bevis, Kerri S. Acemgil, Aras Taylor, Richard A. Demark-Wahnefried, Wendy Kenzik, Kelly Li, Yufeng Meneses, Karen Martin, Michelle Fouad, Mona N. Pisu, Maria Partridge, Edward E. 0732-183X 1527-7755 American Society of Clinical Oncology (ASCO) Cancer Research Oncology http://dx.doi.org/10.1200/jco.2015.33.29_suppl.155 <jats:p> 155 </jats:p><jats:p> Background: Healthcare utilization and costs escalate near diagnosis and in the final months of life. There is a national trend toward aggressive care at end of life (EOL). We examined patterns in utilization and cost across the trajectory of care and during the last two weeks of life during implementation of a lay navigation intervention. Methods: Claims data were obtained for Medicare beneficiaries ≥ 65 years old with cancer in the UAB Health System Cancer Community Network (UAB CCN). For 10 quarters from January 2012 -June 2014, we examined healthcare utilization for the population at large, navigated patients, and decedents. All analyses included ER visits, hospitalizations, and ICU admissions and use of chemotherapy in the last 2 weeks of life, and hospice utilization (admission or less than 3 days of hospice) in the quarter of death for decedents. Descriptive analyses and linear regression were used to test trends over time; general linear models evaluated changes in health care utilization and cost. Results: Across the population reduction of 13.4% to 11% for hospitalization (18% decrease, p < 0.01), 8.0% to 7.1% for ER visits (12% decrease, p < 0.01), 2.9% to 2.5% for ICU admissions (14% decrease, p = 0.04) and an increase of 3.9% to 4.3% for hospice (9.2% increase p = 0.37) were found. Among 5,861 decedents, in the last 2 weeks of life, there were decreases in ICU admissions (14.6% decrease, p = 0.11), from 39.2% to 32.0%, ER visits (18.4% decrease, p = 0.03), and chemotherapy, from 4.7% to 3.5% (25.5% decrease, p = 0.11).Over the 10 quarters, hospice enrollment increased from 70.7% to 77.4% (9.48% increase; p = 0.06), and the proportion of patients on hospice for less than 3 days changed from 7.8% to 7.5% (3.85% decrease, p = 0.30). Costs decreased about $158 per quarter per beneficiary. A significant pre-post decrease of $952 per beneficiary (p < 0.01) led to an estimated reduction in Medicare costs of $18,406,920 for the 19,335 beneficiaries in the UAB CCN for the five quarters post-implementation. Conclusions: We observed decreased healthcare utilization and cost and trends toward decreased aggressive care at EOL in the UAB CCN. Further work is needed to determine the impact of navigation on utilization trends. </jats:p> Trends in health care utilization, cost, and aggressive care at end of life among older cancer patients in the Deep South. Journal of Clinical Oncology |
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Journal of Clinical Oncology |
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| title |
Trends in health care utilization, cost, and aggressive care at end of life among older cancer patients in the Deep South. |
| title_unstemmed |
Trends in health care utilization, cost, and aggressive care at end of life among older cancer patients in the Deep South. |
| title_full |
Trends in health care utilization, cost, and aggressive care at end of life among older cancer patients in the Deep South. |
| title_fullStr |
Trends in health care utilization, cost, and aggressive care at end of life among older cancer patients in the Deep South. |
| title_full_unstemmed |
Trends in health care utilization, cost, and aggressive care at end of life among older cancer patients in the Deep South. |
| title_short |
Trends in health care utilization, cost, and aggressive care at end of life among older cancer patients in the Deep South. |
| title_sort |
trends in health care utilization, cost, and aggressive care at end of life among older cancer patients in the deep south. |
| topic |
Cancer Research Oncology |
| url |
http://dx.doi.org/10.1200/jco.2015.33.29_suppl.155 |
| publishDate |
2015 |
| physical |
155-155 |
| description |
<jats:p> 155 </jats:p><jats:p> Background: Healthcare utilization and costs escalate near diagnosis and in the final months of life. There is a national trend toward aggressive care at end of life (EOL). We examined patterns in utilization and cost across the trajectory of care and during the last two weeks of life during implementation of a lay navigation intervention. Methods: Claims data were obtained for Medicare beneficiaries ≥ 65 years old with cancer in the UAB Health System Cancer Community Network (UAB CCN). For 10 quarters from January 2012 -June 2014, we examined healthcare utilization for the population at large, navigated patients, and decedents. All analyses included ER visits, hospitalizations, and ICU admissions and use of chemotherapy in the last 2 weeks of life, and hospice utilization (admission or less than 3 days of hospice) in the quarter of death for decedents. Descriptive analyses and linear regression were used to test trends over time; general linear models evaluated changes in health care utilization and cost. Results: Across the population reduction of 13.4% to 11% for hospitalization (18% decrease, p < 0.01), 8.0% to 7.1% for ER visits (12% decrease, p < 0.01), 2.9% to 2.5% for ICU admissions (14% decrease, p = 0.04) and an increase of 3.9% to 4.3% for hospice (9.2% increase p = 0.37) were found. Among 5,861 decedents, in the last 2 weeks of life, there were decreases in ICU admissions (14.6% decrease, p = 0.11), from 39.2% to 32.0%, ER visits (18.4% decrease, p = 0.03), and chemotherapy, from 4.7% to 3.5% (25.5% decrease, p = 0.11).Over the 10 quarters, hospice enrollment increased from 70.7% to 77.4% (9.48% increase; p = 0.06), and the proportion of patients on hospice for less than 3 days changed from 7.8% to 7.5% (3.85% decrease, p = 0.30). Costs decreased about $158 per quarter per beneficiary. A significant pre-post decrease of $952 per beneficiary (p < 0.01) led to an estimated reduction in Medicare costs of $18,406,920 for the 19,335 beneficiaries in the UAB CCN for the five quarters post-implementation. Conclusions: We observed decreased healthcare utilization and cost and trends toward decreased aggressive care at EOL in the UAB CCN. Further work is needed to determine the impact of navigation on utilization trends. </jats:p> |
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| author | Kvale, Elizabeth Ann, Rocque, Gabrielle, Bevis, Kerri S., Acemgil, Aras, Taylor, Richard A., Demark-Wahnefried, Wendy, Kenzik, Kelly, Li, Yufeng, Meneses, Karen, Martin, Michelle, Fouad, Mona N., Pisu, Maria, Partridge, Edward E. |
| author_facet | Kvale, Elizabeth Ann, Rocque, Gabrielle, Bevis, Kerri S., Acemgil, Aras, Taylor, Richard A., Demark-Wahnefried, Wendy, Kenzik, Kelly, Li, Yufeng, Meneses, Karen, Martin, Michelle, Fouad, Mona N., Pisu, Maria, Partridge, Edward E., Kvale, Elizabeth Ann, Rocque, Gabrielle, Bevis, Kerri S., Acemgil, Aras, Taylor, Richard A., Demark-Wahnefried, Wendy, Kenzik, Kelly, Li, Yufeng, Meneses, Karen, Martin, Michelle, Fouad, Mona N., Pisu, Maria, Partridge, Edward E. |
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| description | <jats:p> 155 </jats:p><jats:p> Background: Healthcare utilization and costs escalate near diagnosis and in the final months of life. There is a national trend toward aggressive care at end of life (EOL). We examined patterns in utilization and cost across the trajectory of care and during the last two weeks of life during implementation of a lay navigation intervention. Methods: Claims data were obtained for Medicare beneficiaries ≥ 65 years old with cancer in the UAB Health System Cancer Community Network (UAB CCN). For 10 quarters from January 2012 -June 2014, we examined healthcare utilization for the population at large, navigated patients, and decedents. All analyses included ER visits, hospitalizations, and ICU admissions and use of chemotherapy in the last 2 weeks of life, and hospice utilization (admission or less than 3 days of hospice) in the quarter of death for decedents. Descriptive analyses and linear regression were used to test trends over time; general linear models evaluated changes in health care utilization and cost. Results: Across the population reduction of 13.4% to 11% for hospitalization (18% decrease, p < 0.01), 8.0% to 7.1% for ER visits (12% decrease, p < 0.01), 2.9% to 2.5% for ICU admissions (14% decrease, p = 0.04) and an increase of 3.9% to 4.3% for hospice (9.2% increase p = 0.37) were found. Among 5,861 decedents, in the last 2 weeks of life, there were decreases in ICU admissions (14.6% decrease, p = 0.11), from 39.2% to 32.0%, ER visits (18.4% decrease, p = 0.03), and chemotherapy, from 4.7% to 3.5% (25.5% decrease, p = 0.11).Over the 10 quarters, hospice enrollment increased from 70.7% to 77.4% (9.48% increase; p = 0.06), and the proportion of patients on hospice for less than 3 days changed from 7.8% to 7.5% (3.85% decrease, p = 0.30). Costs decreased about $158 per quarter per beneficiary. A significant pre-post decrease of $952 per beneficiary (p < 0.01) led to an estimated reduction in Medicare costs of $18,406,920 for the 19,335 beneficiaries in the UAB CCN for the five quarters post-implementation. Conclusions: We observed decreased healthcare utilization and cost and trends toward decreased aggressive care at EOL in the UAB CCN. Further work is needed to determine the impact of navigation on utilization trends. </jats:p> |
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| spelling | Kvale, Elizabeth Ann Rocque, Gabrielle Bevis, Kerri S. Acemgil, Aras Taylor, Richard A. Demark-Wahnefried, Wendy Kenzik, Kelly Li, Yufeng Meneses, Karen Martin, Michelle Fouad, Mona N. Pisu, Maria Partridge, Edward E. 0732-183X 1527-7755 American Society of Clinical Oncology (ASCO) Cancer Research Oncology http://dx.doi.org/10.1200/jco.2015.33.29_suppl.155 <jats:p> 155 </jats:p><jats:p> Background: Healthcare utilization and costs escalate near diagnosis and in the final months of life. There is a national trend toward aggressive care at end of life (EOL). We examined patterns in utilization and cost across the trajectory of care and during the last two weeks of life during implementation of a lay navigation intervention. Methods: Claims data were obtained for Medicare beneficiaries ≥ 65 years old with cancer in the UAB Health System Cancer Community Network (UAB CCN). For 10 quarters from January 2012 -June 2014, we examined healthcare utilization for the population at large, navigated patients, and decedents. All analyses included ER visits, hospitalizations, and ICU admissions and use of chemotherapy in the last 2 weeks of life, and hospice utilization (admission or less than 3 days of hospice) in the quarter of death for decedents. Descriptive analyses and linear regression were used to test trends over time; general linear models evaluated changes in health care utilization and cost. Results: Across the population reduction of 13.4% to 11% for hospitalization (18% decrease, p < 0.01), 8.0% to 7.1% for ER visits (12% decrease, p < 0.01), 2.9% to 2.5% for ICU admissions (14% decrease, p = 0.04) and an increase of 3.9% to 4.3% for hospice (9.2% increase p = 0.37) were found. Among 5,861 decedents, in the last 2 weeks of life, there were decreases in ICU admissions (14.6% decrease, p = 0.11), from 39.2% to 32.0%, ER visits (18.4% decrease, p = 0.03), and chemotherapy, from 4.7% to 3.5% (25.5% decrease, p = 0.11).Over the 10 quarters, hospice enrollment increased from 70.7% to 77.4% (9.48% increase; p = 0.06), and the proportion of patients on hospice for less than 3 days changed from 7.8% to 7.5% (3.85% decrease, p = 0.30). Costs decreased about $158 per quarter per beneficiary. A significant pre-post decrease of $952 per beneficiary (p < 0.01) led to an estimated reduction in Medicare costs of $18,406,920 for the 19,335 beneficiaries in the UAB CCN for the five quarters post-implementation. Conclusions: We observed decreased healthcare utilization and cost and trends toward decreased aggressive care at EOL in the UAB CCN. Further work is needed to determine the impact of navigation on utilization trends. </jats:p> Trends in health care utilization, cost, and aggressive care at end of life among older cancer patients in the Deep South. Journal of Clinical Oncology |
| spellingShingle | Kvale, Elizabeth Ann, Rocque, Gabrielle, Bevis, Kerri S., Acemgil, Aras, Taylor, Richard A., Demark-Wahnefried, Wendy, Kenzik, Kelly, Li, Yufeng, Meneses, Karen, Martin, Michelle, Fouad, Mona N., Pisu, Maria, Partridge, Edward E., Journal of Clinical Oncology, Trends in health care utilization, cost, and aggressive care at end of life among older cancer patients in the Deep South., Cancer Research, Oncology |
| title | Trends in health care utilization, cost, and aggressive care at end of life among older cancer patients in the Deep South. |
| title_full | Trends in health care utilization, cost, and aggressive care at end of life among older cancer patients in the Deep South. |
| title_fullStr | Trends in health care utilization, cost, and aggressive care at end of life among older cancer patients in the Deep South. |
| title_full_unstemmed | Trends in health care utilization, cost, and aggressive care at end of life among older cancer patients in the Deep South. |
| title_short | Trends in health care utilization, cost, and aggressive care at end of life among older cancer patients in the Deep South. |
| title_sort | trends in health care utilization, cost, and aggressive care at end of life among older cancer patients in the deep south. |
| title_unstemmed | Trends in health care utilization, cost, and aggressive care at end of life among older cancer patients in the Deep South. |
| topic | Cancer Research, Oncology |
| url | http://dx.doi.org/10.1200/jco.2015.33.29_suppl.155 |