Evidence map›Paper›PMID 38721884›Full record

ArticleJournal of the American Geriatrics Society2024

Association between physician age and patterns of end-of-life care among older Americans.

Hiroshi Gotanda, Ryo Ikesu, Anne M Walling, Jessica J Zhang, Haiyong Xu, David B Reuben, Neil S Wenger, Cheryl L Damberg, David S Zingmond, Anupam B Jena and 2 more

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In one paragraph

Article in Journal of the American Geriatrics Society, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
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

5 citing papers in PubMed.

  1. Article
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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

12 authors.

Hiroshi GotandaDivision of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Ryo IkesuDivision of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Anne M WallingDivision of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Jessica J ZhangDepartment of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Haiyong XuDivision of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
David B ReubenMulticampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Neil S WengerDivision of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.ORCID 0000-0002-9884-3967
Cheryl L DambergRAND Corporation, Santa Monica, California, USA.
David S ZingmondDivision of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Anupam B JenaDepartment of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA.
Nate GrossDoximity, San Francisco, California, USA.
Yusuke TsugawaDivision of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.

Funding

NRSA Training CoreTL1TR001883 · NCATS · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI ALEX BUI, Nina Thawata Harawa · 2016 to 2026
$8.6M
The Impact of Surgeon Factors and Education/Training on Disparities in Surgical Care.R01MD013913 · NIMHD · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI TSUGAWA, YUSUKE · 2020 to 2024
$3.6M
The Impact of physician and health system factors on the quality of care for persons with Alzheimer's disease and related dementias at the end of lifeR01AG068633 · NIA · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI TSUGAWA, YUSUKE · 2020 to 2024
$3.0M
The effect of medical school, residency program, and health system board diversities on racial and ethnic disparities in AD/ADRD care.R01AG082991 · NIA · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI Yusuke Tsugawa · 2023 to 2026
$2.1M
Days spent at home: a patient-centered outcome measure for persons with Alzheimer's disease and related dementiasR03AG073993 · NIA · CEDARS-SINAI MEDICAL CENTER · PI GOTANDA, HIROSHI · 2021 to 2022
$334k
Gregory Annenberg Weingarten, GRoW @ AnnenbergNCATS NIH HHS TL1 TR001883NIA NIH HHS R01 AG068633NIA NIH HHS R01AG068633NIA NIH HHS R01 AG082991NIA NIH HHS R03 AG073993NIA NIH HHS R03AG073993NIMHD NIH HHS R01 MD013913
6 · The paper itself

Abstract

backgroundEnd-of-life (EOL) care patterns may differ by physician age given differences in how physicians are trained or changes associated with aging. We sought to compare patterns of EOL care delivered to older Americans according to physician age.

methodsWe conducted a cross-sectional study of a 20% sample of Medicare fee-for-service beneficiaries aged ≥66 years who died in 2016-2019 (n = 487,293). We attributed beneficiaries to the physician who had >50% of primary care visits during the last 6 months of life. We compared beneficiary-level outcomes by physician age (<40, 40-49, 50-59, or ≥60) in two areas: (1) advance care planning (ACP) and palliative care; and (2) high-intensity care at the EOL.

resultsBeneficiaries attributed to younger physicians had slightly higher proportions of billed ACP (adjusted proportions, 17.1%, 16.1%, 15.5%, and 14.0% for physicians aged <40, 40-49, 50-59, and ≥60, respectively; p-for-trend adjusted for multiple comparisons <0.001) and palliative care counseling or hospice use in the last 180 days of life (64.5%, 63.6%, 61.9%, and 60.8%; p-for-trend <0.001). Similarly, physicians' younger age was associated with slightly lower proportions of emergency department visits (57.4%, 57.0%, 57.4%, and 58.1%; p-for-trend <0.001), hospital admissions (51.2%, 51.1%, 51.4%, and 52.1%; p-for-trend <0.001), intensive care unit admissions (27.8%, 27.9%, 28.2%, and 28.3%; p-for-trend = 0.03), or mechanical ventilation or cardiopulmonary resuscitation (14.2, 14.9%, 15.2%, and 15.3%; p-for-trend <0.001) in the last 30 days of life, and in-hospital death (20.2%, 20.6%, 21.3%, and 21.5%; p-for-trend <0.001).

conclusionsWe found that differences in patterns of EOL care between beneficiaries cared for by younger and older physicians were small, and thus, not clinically meaningful. Future research is warranted to understand the factors that can influence patterns of EOL care provided by physicians, including initial and continuing medical education.

Indexed as

Advance Care PlanningMedicarePhysiciansTerminal CareAdultAgedAged, 80 and overAge FactorsCross-Sectional StudiesFemaleHumansMaleMiddle AgedPalliative CarePractice Patterns, Physicians'United Statesadvance care planningend‐of‐life carepalliative carephysician age

Identifiers

PMID38721884
PMCPMC11226372

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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.