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Health Serv Res. 2016 Aug;51(4):1584-94. doi: 10.1111/1475-6773.12440. Epub 2016 Jan 22.

Dartmouth Atlas Area-Level Estimates of End-of-Life Expenditures: How Well Do They Reflect Expenditures for Prospectively Identified Advanced Lung Cancer Patients?

Author information

1
Department of Health Care Policy, Harvard Medical School, Boston, MA.
2
Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA.
3
Center for Research on End-of-Life Care, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY.
4
Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA.
5
Department of Radiology, Weill Cornell Medical College, New York, NY.
6
Center for Health Research, Kaiser Permanente Northwest, Portland, OR.
7
VA HSR&D Center for Health Information and Communication, Indiana University School of Medicine, Indianapolis, IN.

Abstract

OBJECTIVE:

Assess validity of the retrospective Dartmouth hospital referral region (HRR) end-of-life spending measures by comparing with health care expenditures from diagnosis to death for prospectively identified advanced lung cancer patients.

DATA/SETTING/DESIGN:

We calculated health care spending from diagnosis (2003-2005) to death or through 2011 for 885 patients aged ≥65 years with advanced lung cancer using Medicare claims. We assessed the association between Dartmouth HRR-level spending in the last 2 years of life and patient-level spending using linear regression with random HRR effects, adjusting for patient characteristics.

FINDINGS:

For each $1 increase in the Dartmouth metric, spending for our cohort increased by $0.74 (p < .001). The Dartmouth spending variable explained 93.4 percent of the HRR-level variance in observed spending.

CONCLUSIONS:

HRR-level spending estimates for deceased patient cohorts reflect area-level care intensity for prospectively identified advanced lung cancer patients.

KEYWORDS:

Variation; health care expenditures; lung cancer

PMID:
26799913
PMCID:
PMC4946029
DOI:
10.1111/1475-6773.12440
[Indexed for MEDLINE]
Free PMC Article

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