Observational studyJournal of the American Geriatrics Society2019
Aggressive Care near the End of Life for Cancer Patients in Medicare Accountable Care Organizations.
Observational study in Journal of the American Geriatrics Society, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
10 citing papers in PubMed, 23 citations in OpenAlex.
- Specialist Palliative Care Use and End-of-Life Care in Patients With Metastatic Cancer.Journal of pain and symptom management · 2024Article
- Vertical integration of oncologists and cancer outcomes and costs in metastatic castration-resistant prostate cancer.Journal of the National Cancer Institute · 2023Article
- Incidence of Aggressive End-of-Life Care Among Older Adults With Metastatic Cancer Living in Nursing Homes and Community Settings.JAMA network open · 2023Article
- ACO Spending and Utilization Among Medicare Patients at the End of Life: an Observational Study.Journal of general internal medicine · 2022Observational
- Spending outcomes among patients with cancer in accountable care organizations 4 years after implementation.Cancer · 2022Article
- Article
- Development of a Machine Learning Model Using Limited Features to Predict 6-Month Mortality at Treatment Decision Points for Patients With Advanced Solid Tumors.JCO clinical cancer informatics · 2022Article
- Palliative care to cancer patients: how COVID-19 pandemic could affect quality of care.Einstein (Sao Paulo, Brazil) · 2022Article
- Article
- The Effect of Network-Level Payment Models on Care Network Performance: A Scoping Review of the Empirical Literature.International journal of integrated careArticle
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
Abstract
objectivesTo compare aggressiveness of end-of-life (EoL) care for older cancer patients attributed to Medicare Shared Savings Programs with that for similar fee for service (FFS) beneficiaries not in an accountable care organization (ACO) and examine whether observed differences in EoL care utilization vary across markets that differ in ACO penetration.
designCross-sectional observational study comparing ACO-attributed beneficiaries with propensity score-matched beneficiaries not attributed to an ACO.
settingA total of 21 hospital referral regions (HRRs) in the United States.
participantsMedicare FFS beneficiaries with a cancer diagnosis who were 66 years or older and died in 2013-2014. MEASUREMENTS: Outcome measures were claims-based quality measures of aggressive EoL care: (1) one or more intensive care unit (ICU) admissions in the last month of life, (2) two or more hospitalizations in the last month of life, (3) two or more emergency department visits in the last month of life, (4) chemotherapy 2 weeks or less before death, and (5) no hospice enrollment or hospice enrollment within 3 days of death. Analyses were adjusted for demographic and clinical characteristics of beneficiaries and practice characteristics.
resultsCompared with beneficiaries not in an ACO, ACO-attributed beneficiaries had a higher rate of ICU admission during the last month of life (37.7% vs 34.0%; adjusted difference = +2.8 percentage points; 95% confidence interval (CI) = 1.0-4.6) but fewer repeated hospitalizations (14.5% vs 15.2%; adjusted difference = -1.7 percentage points; CI = -3.1 to -.3). Other measures did not differ for the two groups. Although the ICU admission rates tended to decrease as ACO-penetration rates increased (P < .01), ACO patients had higher rates of ICU admission than non-ACO patients in both medium and high ACO-penetration HRRs.
conclusionCancer patients attributed to ACOs had fewer repeated hospitalizations but more ICU admissions in the last month of life than non-ACO patients; they had similar rates of other measures of aggressive care at the EoL. This suggests opportunities for ACOs to improve EoL care for cancer patients. J Am Geriatr Soc 67:961-968, 2019.
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