Table 2.
Trends in Site of Death, Place of Care, and Transitions Between 2000, 2005, and 2009a
| % (95% CI)
|
|||||||||
|---|---|---|---|---|---|---|---|---|---|
| All Decedents
|
Cancer
|
COPD
|
Dementia
|
||||||
| 2000 (n = 270 202) | 2005 (n = 291 819) | 2009 (n = 286 282) | 2000 (n = 49 735) | 2009 (n = 55 362) | 2000 (n = 79 284) | 2009 (n = 91 517) | 2000 (n = 59 065) | 2009 (n = 67 861) | |
| Site of deathb | |||||||||
| Home | 30.7 (30.6–30.9) | 34.9 (35.7–35.1) | 33.5 (33.3–33.6) | 41.5 (41.1–41.9) | 43.4 (43.0–43.8) | 24.0 (23.7–24.3) | 28.0 (27.8–28.3) | 19.9 (19.6–20.2) | 22.8 (22.4–23.1) |
|
| |||||||||
| Acute care hospital | 32.6 (32.4–32.8) | 26.9 (26.7–27.1) | 24.6 (24.5–24.8) | 30.1 (29.7–30.5) | 22.1 (21.7–22.4) | 44.2 (43.9–44.6) | 31.7 (31.4–32.0) | 28.6 (28.3–29.0) | 17.5 (17.2–17.7) |
|
| |||||||||
| Nursing home | 27.2 (27.0–27.3) | 25.3 (25.1–25.4) | 27.6 (27.4–27.8) | 17.0 (16.7–17.3) | 17.1 (16.8–17.5) | 22.3 (22.0–22.6) | 24.3 (24.0–24.6) | 45.6 (45.1–46.0) | 48.8 (48.4–49.1) |
|
| |||||||||
| Place of carec | |||||||||
| Hospice at time of death | 21.6 (21.4–21.7) | 32.3 (32.1–32.5) | 42.2 (42.0–42.4) | 45.1 (44.6–45.5) | 59.5 (59.1–59.9) | 19.5 (19.2–19.8) | 39.0 (38.7–39.3) | 19.5 (19.2–19.8) | 48.3 (48.0–48.7) |
|
| |||||||||
| Hospice ≤3 d | 4.6 (4.5–4.7) | 7.6 (7.5–7.7) | 9.8 (9.7–10.0) | 7.6 (7.4–7.8) | 12.7 (12.5–13.0) | 5.0 (4.9–5.2) | 11.5 (11.3–11.7) | 5.2 (5.0–5.3) | 10.5 (10.3–10.8) |
|
| |||||||||
| GIP level of hospice care in last mo | 3.9 (3.8–4.0) | 8.0 (7.9–8.1) | 11.3 (11.1–11.4) | 8.4 (8.2–8.7) | 17.8 (17.5–18.2) | 4.2 (4.1–4.4) | 12.6 (12.4–12.9) | 3.7 (3.5–3.8) | 11.4 (11.1–11.6) |
|
| |||||||||
| Continuous care level of hospice care in last mo | 0.94 (0.91–0.98) | 2.3 (2.2–2.3) | 3.1 (3.0–3.1) | 1.8 (1.6–1.9) | 4.2 (4.0–4.4) | 0.83 (0.77–0.90) | 2.9 (2.8–3.0) | 0.91 (0.83–0.99) | 3.9 (3.7–4.0) |
|
| |||||||||
| Nursing home stay in last 90 d | 42.8 (42.6–43.0) | 42.2 (42.0–42.4) | 45.0 (44.8–45.2) | 28.6 (28.2–29.0) | 31.3 (30.9–31.7) | 42.2 (41.9–42.6) | 47.4 (47.1–47.7) | 70.9 (70.5–71.3) | 72.1 (71.8–72.5) |
|
| |||||||||
| Hospitalization in last 90 d | 62.9 (62.7–63.1) | 62.8 (62.7–63.0) | 69.3 (69.2–69.6) | 75.0 (74.6–75.4) | 80.3 (80.0–80.6) | 81.6 (81.4–81.9) | 82.8 (82.6–83.1) | 69.9 (69.5–70.2) | 65.2 (64.8–65.6) |
|
| |||||||||
| ICU in last 30 d | 24.3 (24.1–24.5) | 26.3 (26.1–26.5) | 29.2 (29.0–29.3) | 19.9 (19.6–20.3) | 26.8 (26.5–27.2) | 36.6 (36.3–37.0) | 39.9 (39.6–40.2) | 18.6 (18.3–18.9) | 21.8 (21.5–22.2) |
|
| |||||||||
| Transitionsc | |||||||||
| Rate in last 90 d per decedent, mean (median) (IQR) | 2.1 (1.0) (0–3.0) | 2.8 (2.0) (1.0–4.0) | 3.1 (2.0) (1.0–5.0) | 2.8 (2.0) (1.0–4.0) | 4.1 (4.0) (2.0–6.0) | 2.8 (2.0) (1.0–4.0) | 3.9 (3.0) (1.0–6.0) | 2.4 (2.0) (1.0–4.0) | 3.1 (3.0) (1.0–5.0) |
|
| |||||||||
| Transition in last 3 d | 10.3 (10.1–10.4) | 12.4 (12.3–12.5) | 14.2 (14.0–14.3) | 11.0 (10.7–11.3) | 15.5 (15.2–15.8) | 12.1 (11.9–12.3) | 17.1 (16.8–17.3) | 15.2 (15.0–15.5) | 16.5 (16.3–16.8) |
|
| |||||||||
| ≥3 Hospitalizations in last 90 d | 10.3 (10.2–10.4) | 10.9 (10.8–11.0) | 11.5 (11.4–11.6) | 13.2 (12.9–13.5) | 14.4 (14.1–14.7) | 17.9 (17.6–18.1) | 19.1 (18.8–19.3) | 12.0 (11.7–12.3) | 10.7 (10.5–11.0) |
|
| |||||||||
| Utilization measuresc | |||||||||
| Mechanical ventilation in last 30 d | 8.3 (8.2–8.4) | 8.6 (8.4–8.6) | 9.3 (9.2–9.4) | 5.9 (5.7–6.1) | 6.7 (6.4–6.8) | 13.3 (13.1–13.5) | 13.0 (12.7–13.2) | 5.1 (4.9–5.3) | 5.2 (5.0–5.4) |
|
| |||||||||
| Hospital days, mean (median) (IQR) | |||||||||
| Last 30 d | 4.9 (1.0) (0–8.0) | 4.8 (1.0) (0–7.0) | 4.6 (1.0) (0–7.0) | 6.0 (3.0) (0–9.0) | 5.3 (3.0) (0–8.0) | 7.5 (5.0) (0–12.0) | 6.6 (4.0) (0–10.0) | 5.1 (2.0) (0–8.0) | 4.0 (0) (0–6.0) |
|
| |||||||||
| Last 90 d | 8.5 (4.0) (0–12.0) | 8.5 (4.0) (0–12.0) | 8.2 (4.0) (0–11.0) | 10.8 (7.0) (2.0–15.0) | 9.7 (6.0) (1.0–13.0) | 13.2 (9.0) (3.0–18.0) | 12.0 (7.0) (2.0–17.0) | 9.5 (6.0) (0–13.0) | 7.7 (4.0) (0–10.0) |
|
| |||||||||
| ICU days, mean (median) (IQR) | |||||||||
| Last 30 d | 1.5 (0) (0–0) | 1.7 (0) (0–1.0) | 1.8 (0) (0–1.0) | 1.2 (0) (0–1.0) | 1.6 (0) (0–1.0) | 2.6 (0) (0–3.0) | 2.8 (0) (0–3.0) | 0.9 (0) (0–0) | 1.2 (0) (0–0) |
|
| |||||||||
| Last 90 d | 2.3 (0) (0–1.0) | 2.7 (0) (0–2.0) | 2.9 (0) (0–3.0) | 1.9 (0) (0–5.0) | 2.7 (0) (0–6.0) | 4.1 (0) (0–1.0) | 4.7 (0) (0–1.0) | 1.6 (0) (0–1.0) | 2.1 (0) (0–1.0) |
|
| |||||||||
| Hospice days, mean (median) (IQR) | |||||||||
| Last 30 d | 3.3 (0) (0–0) | 5.0 (0) (0–4.0) | 6.6 (0) (0–9.0) | 7.6 (0) (0–14.0) | 9.1 (3.0) (0–19.0) | 2.8 (0) (0–0) | 5.4 (0) (0–6.0) | 2.6 (0) (0–0) | 7.5 (1.0) (0–13.0) |
|
| |||||||||
| Last 90 d | 6.0 (0) (0–0) | 9.8 (0) (0–4.0) | 13.2 (0) (0–10.0) | 12.7 (0) (0–15.0) | 15.7 (3.0) (0–20.0) | 4.7 (0) (0–0) | 10.0 (0) (0–6.0) | 4.4 (0) (0–0) | 15.1 (1.0) (0–14.0) |
Abbreviations: COPD, chronic obstructive pulmonary disease; GIP, general inpatient; ICU, intensive care unit; IQR, interquartile range.
a
All sample sizes correspond to a random 20% sample of all fee-for-service Medicare decedents in each year.
b
Percentages that do not sum to 100% reflect deaths in the emergency department, other types of hospitals, and freestanding hospice inpatient units. In 2009, the difference mainly consisted of decedents with GIP level of hospice care in an acute care hospital (3.2%) or freestanding hospice inpatient unit (5.4%).
c
Periods of time labeled as “last” refer to days before death.