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- Title
End-of-life Health-Care Utilization Patterns Among Chronically Ill Older Adults.
- Authors
Greenle, Meredith MacKenzie; Hirschman, Karen B.; Coburn, Ken; Marcantonio, Sherry; Hanlon, Alexandra L.; Naylor, Mary; Mauer, Elizabeth; Ulrich, Connie
- Abstract
Patients with chronic illness are associated with high health-care utilization and this is exacerbated in the end of life, when health-care utilization and costs are highest. Complex Care Management (CCM) is a model of care developed to reduce health-care utilization, while improving patient outcomes. We aimed to examine the relationship between health-care utilization patterns and patient characteristics over time in a sample of older adults enrolled in CCM over the last 2 years of life. Generalized estimating equation models were used. The sample (n = 126) was 52% female with an average age of 85 years. Health-care utilization rose sharply in the last 3 months of life with at least one hospitalization for 67% of participants and an emergency department visit for 23% of participants. In the last 6 months of life, there was an average of 2.17 care transitions per participant. The odds of hospitalization increased by 27% with each time interval (P <.001). Participants demonstrated 11% greater odds of having a hospitalization for each additional comorbidity (P =.05). A primary diagnosis of heart failure or coronary artery disease was associated with 21% greater odds of hospitalization over time compared to other primary diagnoses (P =.017). Females had 70% greater odds of an emergency department visit compared to males (P =.046). For each additional year of life, the odds of an emergency department visit increased by about 7% (P <.001). Findings suggest the need for further interventions targeting chronically ill older adults nearing end of life within CCM models.
- Subjects
CHRONIC diseases; HOSPITAL care; HOSPITAL emergency services; LONGITUDINAL method; RESEARCH methodology; MEDICAL quality control; MEDICAL care use; QUESTIONNAIRES; RESEARCH funding; TERMINAL care; MATHEMATICAL variables; STRUCTURAL equation modeling; RETROSPECTIVE studies; PATIENTS' attitudes; DESCRIPTIVE statistics
- Publication
American Journal of Hospice & Palliative Medicine, 2019, Vol 36, Issue 6, p507
- ISSN
1049-9091
- Publication type
Article
- DOI
10.1177/1049909118824962