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J Am Geriatr Soc. 2002 Jun;50(6):1108-12.

Profiles of older medicare decedents.

Author information

1
RAND Center to Improve Care of the Dying, 1200 South Hayes Street, MSC 6352, Arlington, VA 22202-5050, USA. lunney@rand.org

Abstract

OBJECTIVES:

To evaluate the usefulness of a clinical scheme to classify older decedents to better understand the issues associated with healthcare use and costs in the last year of life.

DESIGN:

We analyzed Medicare claims data for a random sample of 0.1% of all Medicare beneficiaries with expenditures between 1993 and 1998. This sample yielded 7,966 deaths.

SETTING:

Medicare claims data.

PARTICIPANTS:

Medicare beneficiaries.

MEASUREMENTS:

We classified decedents into groups representing four trajectories at the end of life: sudden death, terminal illness, organ failure, and frailty.

RESULTS:

Ninety-two percent of decedents were captured by the profiling strategy. The four trajectory groups had distinct patterns of demographics, care delivery, and Medicare expenditures. Frailty was a dominant pattern, with 47% of all decedents, whereas sudden death claimed only 7%; cancer claimed 22%, and organ system failure, 16%.

CONCLUSIONS:

The clinical scheme to classify decedents appears to fit most decedents and to form groups with substantial clinical differences. Acknowledging the differences among these groups may be a fruitful way to evaluate expenditures and develop strategies to improve care at the end of life.

PMID:
12110073
[Indexed for MEDLINE]

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