Trends in end-of-life cancer care in the Medicare program.

摘要: Abstract Objectives To examine contemporary trends in end-of-life cancer care and geographic variation of aggressiveness among Medicare beneficiaries. Materials Methods Using the Surveillance, Epidemiology, End Results—Medicare data, we identified 132,051 beneficiaries who died as a result 2006–2011. Aggressiveness was measured by chemotherapy received within 14days death, >1 emergency department (ED) visit 30days hospitalization ≥1 intensive unit (ICU) admission in-hospital or hospice enrollment ≤3days before death. hierarchical generalized linear models, assessed potentially aggressive adjusting for patient demographics, tumor characteristics, hospital referral region (HRR)-level market factors. Results The proportion receiving at least one intervention increased from 48.6% 2006 to 50.5% 2011 ( P =.01), repeated ED visits (34.3% vs. 36.6%; =.12). use varied substantially across HRRs, ranging 40.3% 58.3%. Few HRRs had decrease during study period. Conclusions Despite growing focus on providing appropriate care, there has not been an improvement program.