Evidence map›Paper›PMID 39393030›Full record

ArticleNeurology2024

End-of-Life Health Care Service Use and Cost Among Medicare Decedents With Neurodegenerative Diseases.

Whitley W Aamodt, Chuxuan Sun, Nabila Dahodwala, Holly Elser, Andrea L C Schneider, John T Farrar, Norma B Coe, Allison W Willis

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Neurology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.

0numbers the graph read from it
0cells of the map it votes in
11citing 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

11 citing papers in PubMed.

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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.

Whitley W AamodtFrom the Department of Neurology (W.W.A., N.D., H.E., A.L.C.S., A.W.W.), Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (W.W.A., N.D., A.L.C.S., A.W.W.), Perelman School of Medicine, Department of Medical Ethics and Health Policy (C.S., N.B.C.), Leonard Davis Institute of Health Economics (N.D., A.L.C.S., N.B.C., A.W.W.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S., J.T.F., A.W.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.ORCID 0000-0001-8130-2809
Chuxuan SunFrom the Department of Neurology (W.W.A., N.D., H.E., A.L.C.S., A.W.W.), Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (W.W.A., N.D., A.L.C.S., A.W.W.), Perelman School of Medicine, Department of Medical Ethics and Health Policy (C.S., N.B.C.), Leonard Davis Institute of Health Economics (N.D., A.L.C.S., N.B.C., A.W.W.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S., J.T.F., A.W.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Nabila DahodwalaFrom the Department of Neurology (W.W.A., N.D., H.E., A.L.C.S., A.W.W.), Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (W.W.A., N.D., A.L.C.S., A.W.W.), Perelman School of Medicine, Department of Medical Ethics and Health Policy (C.S., N.B.C.), Leonard Davis Institute of Health Economics (N.D., A.L.C.S., N.B.C., A.W.W.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S., J.T.F., A.W.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.ORCID 0000-0003-3659-0244
Holly ElserFrom the Department of Neurology (W.W.A., N.D., H.E., A.L.C.S., A.W.W.), Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (W.W.A., N.D., A.L.C.S., A.W.W.), Perelman School of Medicine, Department of Medical Ethics and Health Policy (C.S., N.B.C.), Leonard Davis Institute of Health Economics (N.D., A.L.C.S., N.B.C., A.W.W.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S., J.T.F., A.W.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.ORCID 0000-0003-1781-904X
Andrea L C SchneiderFrom the Department of Neurology (W.W.A., N.D., H.E., A.L.C.S., A.W.W.), Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (W.W.A., N.D., A.L.C.S., A.W.W.), Perelman School of Medicine, Department of Medical Ethics and Health Policy (C.S., N.B.C.), Leonard Davis Institute of Health Economics (N.D., A.L.C.S., N.B.C., A.W.W.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S., J.T.F., A.W.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.ORCID 0000-0003-0026-5052
John T FarrarFrom the Department of Neurology (W.W.A., N.D., H.E., A.L.C.S., A.W.W.), Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (W.W.A., N.D., A.L.C.S., A.W.W.), Perelman School of Medicine, Department of Medical Ethics and Health Policy (C.S., N.B.C.), Leonard Davis Institute of Health Economics (N.D., A.L.C.S., N.B.C., A.W.W.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S., J.T.F., A.W.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Norma B CoeFrom the Department of Neurology (W.W.A., N.D., H.E., A.L.C.S., A.W.W.), Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (W.W.A., N.D., A.L.C.S., A.W.W.), Perelman School of Medicine, Department of Medical Ethics and Health Policy (C.S., N.B.C.), Leonard Davis Institute of Health Economics (N.D., A.L.C.S., N.B.C., A.W.W.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S., J.T.F., A.W.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Allison W WillisFrom the Department of Neurology (W.W.A., N.D., H.E., A.L.C.S., A.W.W.), Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (W.W.A., N.D., A.L.C.S., A.W.W.), Perelman School of Medicine, Department of Medical Ethics and Health Policy (C.S., N.B.C.), Leonard Davis Institute of Health Economics (N.D., A.L.C.S., N.B.C., A.W.W.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S., J.T.F., A.W.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.ORCID 0000-0001-5724-7192

Funding

Leveraging a Natural Experiment to Determine the Effects of Integrated Palliative Care on Health Service Outcomes and Disparities in Parkinson Disease and Lewy Body DementiaRF1NS132673 · NINDS · UNIVERSITY OF PENNSYLVANIA · PI WILLIS, ALLISON · 2023 to 2023
$2.3M
Midcareer Development Award in Neuroaging and Geriatric Pharmacoepidemiology ResearchK24AG075234 · NIA · UNIVERSITY OF PENNSYLVANIA · PI Allison Willis · 2022 to 2026
$808k
Improving End-of-Life Care for Hospitalized Patients with Lewy Body DisordersK23AG086669 · NIA · UNIVERSITY OF PENNSYLVANIA · PI Whitley Aamodt · 2024 to 2026
$585k
NIA NIH HHS K23 AG086669NIA NIH HHS K24 AG075234NIA NIH HHS L30 AG089647NINDS NIH HHS RF1 NS132673
6 · The paper itself

Abstract

BACKGROUND AND

objectivesAlthough neurodegenerative diseases are a leading cause of death, little is known about health care utilization and cost during the end-of-life (EoL) period or how it compares with that of other life-limiting conditions. We aimed to describe and compare resource utilization among US Medicare decedents with neurodegenerative diseases with decedents with cancer.

methodsWe conducted a retrospective study of Medicare Part A and B beneficiaries with Alzheimer disease (AD), Parkinson disease (PD), or amyotrophic lateral sclerosis (ALS) who died in 2018. Decedents diagnosed with malignant brain tumors or pancreatic cancer served as non-neurodegenerative comparators. Descriptive analyses examined demographic and clinical characteristics in the last year of life. The probabilities and associated costs of emergency department (ED), inpatient, skilled nursing facility (SNF), and hospice utilization during the last 12 and 6 months of life were also compared between persons with neurodegenerative diseases and cancer, adjusting for sociodemographic factors and comorbidity burden.

resultsA total of 1,126,799 Medicare beneficiaries died in 2018, of which 357,926 had a qualifying diagnosis. Persons with neurodegenerative diseases were older and more frequently received Medicaid assistance than persons with brain or pancreatic cancer. In all groups, health care service utilization increased over the last year of life, and total costs were predominantly attributable to inpatient care. In the last 6 months of life, neurologist care was infrequent among patients with neurodegenerative disease (AD: 1.5%; PD: 8.6%; ALS: 32.0%). Persons with neurodegenerative diseases as compared to persons with malignant brain tumors also had greater odds of ED use (AD: adjusted odds ratio [aOR] 1.17, 95% CI 1.11-1.23; PD: aOR 1.18, 95% CI 1.11-1.25; ALS: aOR 1.11, 95% CI 1.01-1.23), lower odds of hospitalization (AD: aOR 0.64, 95% CI 0.60-0.68; PD: aOR 0.65, 95% CI 0.61-0.69; ALS: aOR 0.33, 95% CI 0.30-0.37), and lower odds of hospice enrollment (AD: aOR 0.33, 95% CI 0.31-0.36; PD: aOR 0.33, 95% CI 0.31-0.36; ALS: aOR 0.41, 95% CI 0.36-0.46). The findings were similar in pancreatic cancer. DISCUSSION: Persons with neurodegenerative diseases in the United States are more likely to visit the ED and less likely to use inpatient and hospice services at EoL than persons with brain or pancreatic cancer. These group differences may stem from prognostic uncertainty and reflect inadequate EoL care practices, requiring further investigation to ensure more timely palliative care and hospice referrals.

Indexed as

MedicareNeurodegenerative DiseasesTerminal CareAgedAged, 80 and overAlzheimer DiseaseAmyotrophic Lateral SclerosisEmergency Service, HospitalFemaleHealth Care CostsHospice CareHumansMaleParkinson DiseasePatient Acceptance of Health CareRetrospective Studies

Identifiers

PMID39393030
PMCPMC11469682

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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.