Evidence map›Paper›PMID 31883772›Full record

ArticleThe American journal of medicine2020

End-of-Life Spending and Healthcare Utilization Among Older Adults with Chronic Obstructive Pulmonary Disease.

Anand S Iyer, Christine A Goodrich, Mark T Dransfield, Shama S Alam, Cynthia J Brown, C Seth Landefeld, Marie A Bakitas, Jeremiah R Brown

Open access · greenAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in The American journal of medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
17citing papers in PubMed, 1 pooled it
2.4field-weighted citation impact, top 11% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

The trial behind it

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

17 citing papers in PubMed, 1 synthesis or guideline pooled it, 25 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 2 institutions in 1 country.

Anand S IyerDivision of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Center for Outcomes and Effectiveness Research and Education, Department of Medicine University of Alabama at Birmingham, Birmingham, AL; Lung Health Center, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Center for Palliative and Supportive Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL. Electronic address: aiyer@uabmc.edu.
Christine A GoodrichThe Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH.
Mark T DransfieldDivision of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Lung Health Center, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Veterans Affairs Medical Center, Birmingham, AL.
Shama S AlamThe Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH.
Cynthia J BrownVeterans Affairs Medical Center, Birmingham, AL; Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.
C Seth LandefeldDivision of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.
Marie A BakitasCenter for Palliative and Supportive Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; School of Nursing, University of Alabama at Birmingham, Birmingham, AL.
Jeremiah R BrownDepartment of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH; Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Lebanon, NH.
University of Alabama at Birmingham · USDartmouth College · US

Funding

UAB K12 in Patient Centered Outcomes ResearchK12HS023009 · AHRQ · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI SAAG, KENNETH G · 2014 to 2018
$4.0M
ENABLE: CHF-PC (Comprehensive Heartcare For Patients and Caregivers)R01NR013665 · NINR · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI BAKITAS, MARIE ANNE · 2015 to 2019
$3.6M
Early vs. Later Palliative Cancer Care: Clinical and Biobehavioral EffectsR01NR011871 · NINR · DARTMOUTH COLLEGE · PI BAKITAS, MARIE ANNE · 2009 to 2011
$1.4M
UAB Mentoring Program in COPD Patient Oriented ResearchK24HL140108 · NHLBI · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI DRANSFIELD, MARK T · 2018 to 2022
$439k
AHRQ HHS K12 HS023009NHLBI NIH HHS K24 HL140108NINR NIH HHS R01 NR011871NINR NIH HHS R01 NR013665
6 · The paper itself

Abstract

backgroundEnd-of-life spending and healthcare utilization among older adults with COPD have not been previously described.

methodsWe examined data on Medicare beneficiaries aged 65 years or older with chronic obstructive pulmonary disease (COPD) who died during the period of 2013-2014. End-of-life measures were retrospectively reviewed for 2 years prior to death. Hospital referral regions (HRRs) were categorized into quintiles of age-sex-race-adjusted overall spending during the last 2 years of life. Geographic quintile variation in spending and healthcare utilization was examined across the continuum.

resultsWe investigated data on 146,240 decedents with COPD from 306 HRRs. Age-sex-race-adjusted overall spending per decedent during the last 2 years of life varied significantly nationwide ($61,271±$11,639 per decedent; range: $48,288±$3,665 to $79,453±$9,242). Inpatient care accounted for 40.2% of spending ($24,626±$6,192 per decedent). Overall, 82%±4% of decedents were admitted to the hospital for 13.7±3.1 days, and 55%±11% were admitted to an intensive care unit for 5.4±2.5 days. Compared with HRRs in the lowest spending quintile, HRRs in the highest spending quintile had a 1.5-fold longer hospital length of stay. Skilled nursing facilities accounted for 11.6% of spending ($7101±$2403 per decedent), and these facilities were utilized by 38%±7% of decedents for 18.7±4.9 days. Hospice accounted for 10.3% of spending ($6,307±$2,201 per decedent) and was utilized by 47%±9% of decedents for 39.7±14.8 days. Significant geographic variation in hospice utilization existed nationwide.

conclusionsEnd-of-life spending and healthcare utilization among older adults with COPD varied substantially nationwide. Decedents with COPD frequently utilized acute care near the end of life. Hospice utilization was higher than expected, with significant geographic disparities.

Indexed as

AgedCost-Benefit AnalysisFemaleHealth ExpendituresHumansMalePatient Acceptance of Health CarePulmonary Disease, Chronic ObstructiveRetrospective StudiesTerminal CareUnited StatesChronic obstructive pulmonary diseaseCost, Healthcare utilization, Hospice, Palliative care

Identifiers

PMID31883772
PMCPMC7319886
OpenAlexW2997507660

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.