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Change in End of Life Care

Article: Change in End-of-Life Care for Medicare Beneficiaries: Site of Death, Place of Care, and Health Care Transitions in 2000, 2005, and 2009. JAMA. 2013;309(5):470-477.

Summary

Change in site of death, place of care and health care transitions for the elderly.

Abstract

Importance A recent Centers for Disease Control and Prevention report found that more persons die at home. This has been cited as evidence that persons dying in the United States are using more supportive care.

Objective To describe changes in site of death, place of care, and health care transitions between 2000, 2005, and 2009.

Design, Setting, and Patients Retrospective cohort study of a random 20% sample of fee‑for‑service Medicare beneficiaries, aged 66 years and older, who died in 2000 (n = 270 202), 2005 (n = 291 819), or 2009 (n = 286 282). A multivariable regression model examined outcomes in 2000 and 2009 after adjustment for sociodemographic characteristics. Based on billing data, patients were classified as having a medical diagnosis of cancer, chronic obstructive pulmonary disease, or dementia in the last 180 days of life.

Main Outcome Measures Site of death, place of care, rates of health care transitions, and potentially burdensome transitions (eg, health care transitions in the last 3 days of life).

Results Our random 20% sample included 848 303 fee‑for‑service Medicare decedents (mean age, 82.3 years; 57.9% female, 88.1% white). Comparing 2000, 2005, and 2009, the proportion of deaths in acute care hospitals decreased from 32.6% (95% CI, 32.4%‑32.8%) to 26.9% (95% CI, 26.7%‑27.1%) to 24.6% (95% CI, 24.5%‑24.8%), respectively. However, intensive care unit (ICU) use in the last month of life increased from 24.3% (95% CI, 24.1%‑24.5%) to 26.3% (95% CI, 26.1%‑26.5%) to 29.2% (95% CI, 29.0%‑29.3%). (Test of trend P value was <.001 for each variable.) Hospice use at the time of death increased from 21.6% (95% CI, 21.4%‑21.7%) to 32.3% (95% CI, 32.1%‑32.5%) to 42.2% (95% CI, 42.0%‑42.4%), with 28.4% (95% CI, 27.9%‑28.5%) using a hospice for 3 days or less in 2009. Of these late hospice referrals, 40.3% (95% CI, 39.7%‑40.8%) were preceded by hospitalization with an ICU stay. The mean number of health care transitions in the last 90 days of life increased from 2.1 (interquartile range [IQR], 0‑3.0) to 2.8 (IQR, 1.0‑4.0) to 3.1 per decedent (IQR, 1.0‑5.0). The percentage of patients experiencing transitions in the last 3 days of life increased from 10.3% (95% CI, 10.1%‑10.4%) to 12.4% (95% CI, 12.3%‑2.5%) to 14.2% (95% CI, 14.0%‑14.3%).

Conclusion and Relevance Among Medicare beneficiaries who died in 2009 and 2005 compared with 2000, a lower proportion died in an acute care hospital, although both ICU use and the rate of health care transitions increased in the last month of life.

Interview with Joan M. Teno, MD, MS, author of Change in End-of-Life Care for Medicare Beneficiaries: Site of Death, Place of Care, and Health Care Transitions in 2000, 2005, and 2009.

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Cambio en la administración de los cuidados paliativos

Artículo: Cambio en la administración de los cuidados paliativos para beneficiarios de Medicare: lugar de fallecimiento, lugar de prestación de los cuidados y transiciones entre servicios sanitarios en 2000, 2005 y 2009. JAMA. 2013;309(5):470-477.

Summary

Cambio del lugar de fallecimiento, el lugar donde se prestan los cuidados y las transiciones entre servicios sanitarios de personas ancianas.

Entrevista con Joan M. Teno, MD, MS, autor de Cambio en la administración de los cuidados paliativos para beneficiarios de Medicare: lugar de fallecimiento, lugar de prestación de los cuidados y transiciones entre servicios sanitarios en 2000, 2005 y 2009.

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Modification des soins de fin de vie

Article: Modification des soins de fin de vie pour les bénéficiaires de Medicare : lieu du décès, lieu de soins et changements de prestataire -- Années 2000, 2005 et 2009. JAMA. 2013;309(5):470-477.

Summary

Changements relatifs au lieu du décès, au lieu des soins et aux prestataires prenant en charge les personnes âgées.

Entretien avec Joan M. Teno, MD, MS, auteur de Modification des soins de fin de vie pour les bénéficiaires de Medicare : lieu du décès, lieu de soins et changements de prestataire -- Années 2000, 2005 et 2009.

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Cambiamenti nelle cure palliative

Articolo: Variazioni nelle cure terminali per i beneficiari Medicare: luogo del decesso, luogo di cura e trasferimenti ad altre strutture sanitarie nel 2000, 2005 e 2009. JAMA. 2013;309(5):470-477.

Summary

Cambiamenti nel luogo del decesso, nel luogo di cura e nei trasferimenti in altre strutture sanitarie per gli anziani.

Intervista a Joan M. Teno, MD, MS, autore di Variazioni nelle cure terminali per i beneficiari Medicare: luogo del decesso, luogo di cura e trasferimenti ad altre strutture sanitarie nel 2000, 2005 e 2009.

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临终护理的变化

文章: 医保受益人临终护理的变化:2000、2005 和 2009 年死亡地点、护理场所和医疗过渡情况。 JAMA. 2013;309(5):470-477.

Summary

老年人死亡地点、护理场所和医疗过渡的变化情况。

专访 Joan M. Teno, MD, MS, 作者 医保受益人临终护理的变化:2000、2005 和 2009 年死亡地点、护理场所和医疗过渡情况。

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Change in End of Life Care

статья: Change in End-of-Life Care for Medicare Beneficiaries: Site of Death, Place of Care, and Health Care Transitions in 2000, 2005, and 2009. JAMA. 2013;309(5):470-477.

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Интервью с Joan M. Teno, MD, MS автор Change in End-of-Life Care for Medicare Beneficiaries: Site of Death, Place of Care, and Health Care Transitions in 2000, 2005, and 2009.

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Change in End of Life Care

Artigo: Change in End-of-Life Care for Medicare Beneficiaries: Site of Death, Place of Care, and Health Care Transitions in 2000, 2005, and 2009. JAMA. 2013;309(5):470-477.

Summary

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Entrevista com o Joan M. Teno, MD, MS autor de Change in End-of-Life Care for Medicare Beneficiaries: Site of Death, Place of Care, and Health Care Transitions in 2000, 2005, and 2009.

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Wandel in der Sterbebegleitung

Artikel: Wandel in der Sterbebegleitung für Medicare-Versicherte: Sterbeort, Pflegeort und Pflegewechsel in den Jahren 2000, 2005 und 2009. JAMA. 2013;309(5):470-477.

Summary

Veränderungen hinsichtlich Sterbeort, Pflegeort und Pflegewechsel bei älteren Menschen.

Interview mit Joan M. Teno, MD, MS, autor Wandel in der Sterbebegleitung für Medicare-Versicherte: Sterbeort, Pflegeort und Pflegewechsel in den Jahren 2000, 2005 und 2009.

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