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Change in End-of-Life Care for Medicare Beneficiaries: Site of Death, Place of Care, and Health Care Transitions in 2000, 2005, and 2009

Teno, M. J., Gozalo, P. L., Bynum, J. P. W., Lelland, N. E., Miller, S. C. . . . Mor, V. (2013). Change in End-of-Life Care for Medicare Beneficiaries: Site of Death, Place of Care, and Health Care Transitions in 2000, 2005, and 2009. The Journal of the American Medical Association 309 (5): 470-477.

The article focuses on the last days of people aged 66 and above, and tries to identify trends in health care services that determine the choices of settings they prefer. The research tries to establish a link between the transition of health care, the site of death and the choice of care places. This is an interesting article because it expounds on the findings of the Centers of Disease Control (CDC) stating many elderly people die at home. This is important in designing health care programs that improve the services provided to the elderly living their last days. The article also helps those seeking medical care to identify the best settings to take their patients. Sub cohort studies on cancer patients, COPD, and dementia is the focus of the researchers as they identify the reasons for aggressive health care.

 

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The methods used in this research include cohort of random studies where the researches got data from the Medicare denominator folders that keep a record of all patients who died in the years 2000, 2005 and 2009. All the patients aged over 66 years were in the beneficiary scheme. The Medicare reports provided the part A and B claims, and this gave a good base for a cohort study and three sub cohorts. These included patients who died of cancer, dementia and COPD. The three sub cohorts provided consistent data. One more source for the research was the Residential History papers. The latter used to identify key features on where the health care providing changes to the patients, the places where they got medical services and of their death. These papers focused on the final three months of each patient, and included classifying the data into the last three days of the patient’s life and the same time they spent in the hospital. The health care transition, places of care, and of death – provide unique information on the medical services the patient received. This way the time each of the diseased spent in the hospital is calculated. The other important factor is the variation in individual characteristics such as patients’ age, sex, race, residency and ethnicity. This provides an insight of the trends may lead to the difference in examination and treatment. The death sites, transitions, and places were characterized using descriptive analysis while the trends used variance-weighted squares. The incidence rate ratios used the Poisson regression.

The results from the research show that the average age for the cohorts was 82.3. The percentages of the female and males were 57.9% and 88.1% respectively. There was no difference in the socio-demographic factors that led to the deaths (Drass, Kell, Osborn, Bausel, Corcoran, Moskowitz, & Fleming, 1998). The site of deaths was acute care centers for the three sub cohorts. The patients who were beneficiaries of the fee-for-service Medicare scheme recorded a decrease in the number of deaths. The beneficiaries either died in freestanding hospice settings and GIP units. The total of patients who died in hospitals increased over the studied period, and most of them died in Hospice incessant care level. It was evident that the place of care for most patients was the ICU, though most those in the ICU died in other sites like home settings. The number of patients in a hospital setting was low in the final three months, but the days spent in the intensive care unit grown. Transition of the disease increased in the last three days of the patient’s life. The patients with cancer raised the need for hospital care: those suffering from COPD changed to acute health centers while those with dementia opted for hospice. The periods spent in the last ones increased over the years though most of the patients left the hospital setting early. The results match with the findings of the CDC, which showed that most of people aged 65, and above die in home. However, there has been a growth in the number of days patients spend in ICU before their death. Hospitalization during the last three days of their lives was in a hospital and the demand for hospice care increased in 2009 (Cox, Jernigan, Coons, & Draugalis, 2001).

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The article concludes the research by stating there is a raise in demand for intensive health care during the last days of the sub cohorts’ lives. This is in contrast with the CDC reports proving people opt for simple medical services at the final days. The reason is many people are in the ICU during their last three days of life thus the suffering do not give up on treatment easily. The transitions also increased since patients moved to hospice settings providing GIP care.

The article gives a clear view of how the patient’s lives change in the last days of their lives: they change from one hospital setting to another and from one care level. This is evident in the research details. The method of study is strong as well: it focuses on three different, not consecutive years. Therefore, one can see the changes that occur within a five-year period. However, the report does not provide an in-depth of the services offered at each hospital setting and how it affects the choice of care level in the final three months (Kilian & Stubbings, 2007). There is no evident link on the choice of a hospital setting and the decision of patients to go through it during their last days. For example, the cancer patients decide to use hospice services.

The article provides an expressive picture on the last days of patients with chronic illnesses and their seeking of health care in different levels. The scholarly writing piece helps the reader understand the complexity of the aforementioned process. It shows that the type of services provided in one care setting is different in other ones. Future research will help create a link between the changing trends in health seeking behaviors of patients in their last days and the worth of care offered. This is crucial in education and changing the perception of many persons: those people give up on life during their last days. The study will provide an in-depth on the changes in quality care that makes people opt for hospital setting at the last, doomed life period.