Supply-Side Differences Only Modestly Associated with Inpatient Hospitalizations among Medicare Beneficiaries in the Last 6 Months of Life.
J Pain Symptom Manage. 2017 Jul 25;:
Authors: Crouch E, Probst JC, Bennett KJ, Hardin JW
CONTEXT: Inpatient hospitalizations are a driver of expenditures at the end of life and are a useful proxy for the intensity of care at that time.
OBJECTIVES: Our study profiled rural and urban Medicare decedents to examine whether they differed in rates of inpatient hospital admissions in the last 6 months of life.
METHODS: Using a sample of 35,831 beneficiaries from the 2013 Medicare Research Identifiable Files, we examined inpatient hospital utilization patterns for a full 6 months before death. Supply-side variables included the number of hospital beds, certified skilled nursing facility beds, and hospice beds per 1,000 residents, plus primary care provider/population ratios. Patient characteristics included age, sex, race/ethnicity, dual eligibility status, region, and chronic conditions.
RESULTS: In both adjusted and unadjusted analysis, rural versus urban residence was not associated with an increased risk for hospitalization at the end of life among Medicare beneficiaries, nor was there a relationship between the supply of hospital, skilled nursing, and hospice services and the rate of hospitalization. Within rural residents alone, modest effects were found for facility supply. Rural residents in a county without a hospital were slightly less likely than other rural decedents to have been hospitalized during their last 6 months of life but were no less likely to have utilized skilled nursing facilities or hospice.
CONCLUSIONS: The absence of major disparities in utilization suggests that end-of-life care is reasonably equitable for rural Medicare beneficiaries.
PMID: 28754441 [PubMed - as supplied by publisher]