ArticleJournal of the American Geriatrics Society2021
Dying with dementia in Medicare Advantage, Accountable Care Organizations, or traditional Medicare.
Article in Journal of the American Geriatrics Society, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 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.
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.
Who cites it
17 citing papers in PubMed, 19 citations in OpenAlex.
- End-of-life dementia: demographic, clinical as well as direct health care cost differences in nursing homes vs. ordinary housing.BMC health services research · 2026Article
- A Retrospective National Cohort Study of Trends in Mechanical Ventilation Among Veterans Living With Dementia, 2010-2019.Journal of the American Geriatrics Society · 2026Article
- Language Preference Is Associated with Goals-of-Care Communication and End-of-Life Care in Dementia.Journal of general internal medicine · 2026Article
- National trends in the prevalence of dementia in Medicare Advantage and Traditional Medicare.BMC health services research · 2026Article
- End-of-Life Care and Health Care Spending for Medicare Beneficiaries With Dementia in Accountable Care Organizations.JAMA health forum · 2025Article
- Home Health Care and Place of Death in Medicare Beneficiaries With and Without Dementia.The Gerontologist · 2024Article
- Mechanical Ventilation in Older Adults With Dementia: Opportunities to Promote Goal-Concordant Care.Journal of pain and symptom management · 2024Article
- High-Intensity Care for Nursing Home Residents with Severe Dementia Hospitalized at the End of Life: A Mixed Methods Study.Journal of the American Medical Directors Association · 2024Article
- Dementia and electronic health record phenotypes: a scoping review of available phenotypes and opportunities for future research.Journal of the American Medical Informatics Association : JAMIA · 2023Article
- Comparison of the Pathway to Hospice Enrollment Between Medicare Advantage and Traditional Medicare.JAMA health forum · 2023Article
- Association of Medicare Advantage star ratings with patterns of end-of-life care.Journal of the American Geriatrics Society · 2023Article
- End-of-life care trajectories among older adults with lung cancer.Journal of geriatric oncology · 2023Article
- Pain Impacting Quality of Life in Persons with Dementia Dying in the Nursing Home by Alternative Medicare Payment Model.Journal of palliative medicine · 2022Article
- Effects of Medicare advantage on patterns of end-of-life care among Medicare decedents.Health services research · 2022Article
- Mechanical Ventilation and Survival in Patients With Advanced Dementia in Medicare Advantage.Journal of pain and symptom management · 2022Article
- Dementia diagnosis and utilization patterns in a racially diverse population within an integrated health care delivery system.Alzheimer's & dementia (New York, N. Y.) · 2022Article
- Opening the black box: Evaluating the care of people with serious illness in Medicare Advantage.Journal of the American Geriatrics Society · 2021Article
Corrections and comments
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Authors and funding
8 authors at 4 institutions in 1 country.
Funding
Abstract
BACKGROUND/
objectiveMedicare Advantage (MA) and Accountable Care Organizations (ACOs) operate under incentives to reduce burdensome and costly care at the end of life. We compared end-of-life care for persons with dementia who are in MA, ACOs, or traditional Medicare (TM). DESIGN, SETTING, AND
participantsRetrospective study of decedents with dementia enrolled in MA, attributed to an ACO, or in TM. Decedents had a nursing home stay between 91 and 180 days prior to death, two or more functional impairments, and mild to severe cognitive impairment. MEASUREMENTS: Hospitalization, invasive mechanical ventilation (IMV) use, and in-hospital death in the last 30 days of life reported in Medicare billing.
resultsAmong 370,094 persons with dementia, 93,801 (25.4%) were in MA (mean age [SD], 86.9 [7.7], 67.6% female), 39,586 (10.7%) were ACO attributed (mean age [SD], 87.2 [7.6], 67.3% female), and 236,707 (63.9%) were in TM (mean age [SD], 87.0 [7.8], 67.6% female). The proportion hospitalized in the last 30 days of life was higher among TM enrollees (27.9%) and those ACO attributed (28.1%) than among MA enrollees (20.5%, p ≤ 0.001). After adjustment for socio-demographics, cognitive and functional impairments, comorbidities, and Hospital Referral Region, adjusted odds of hospitalization in the 30 days prior to death was 0.72 (95% confidence interval [CI] 0.70-0.74) among MA enrollees and 1.05 (95% CI 1.02-1.09) among those attributed to ACOs relative to TM enrollees. Relative to TM, the adjusted odds of death in the hospital were 0.78 (95% CI 0.75-0.81) among MA enrollees and 1.02 (95% CI 0.96-1.08) for ACO participants. Dementia decedents in MA had a lower likelihood of IMV use (adjusted odds ratio 0.80, 95% CI 0.75-0.85) compared to TM.
conclusionsAmong decedents with dementia, MA enrollees but not decedents in ACOs experienced less costly and potentially burdensome care compared with those with TM. Policy changes are needed for ACOs.
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Registered trials
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.