Table 3.
Multivariable Analysis by Overall Decedents and Medicare Beneficiaries Who Died With a Diagnosis of Cancer, Chronic Obstructive Pulmonary Disease, and Dementiaa
| IRR (95% CI)
|
|||||
|---|---|---|---|---|---|
| All Decedents
|
2009 Compared With 2000
|
||||
| 2005 Compared With 2000 | 2009 Compared With 2000 | Cancer | COPD | Dementia | |
| Site of death | |||||
| Home | 1.13 (1.12–1.15) | 1.11 (1.09–1.12) | 1.05 (1.03–1.08) | 1.19 (1.16–1.21) | 1.15 (1.10–1.19) |
|
| |||||
| Acute care hospital | 0.83 (0.81–0.84) | 0.76 (0.75–0.78) | 0.74 (0.73–0.76) | 0.72 (0.73–0.74) | 0.62 (0.60–0.64) |
|
| |||||
| Nursing home | 0.93 (0.91–0.94) | 0.96 (0.94–0.98) | 0.96 (0.93–0.99) | 1.02 (0.99–1.05) | 1.06 (1.03–1.08) |
|
| |||||
| Places of careb | |||||
| Hospice | 1.50 (1.47–1.53) | 1.94 (1.88–2.00) | 1.32 (1.30–1.35) | 2.00 (1.93–2.06) | 2.49 (2.36–2.63) |
|
| |||||
| Hospice ≤3 d | 1.66 (1.60–1.72) | 2.15 (2.04–2.26) | 1.68 (1.60–1.77) | 2.28 (2.14–2.42) | 2.19 (2.04–2.34) |
|
| |||||
| GIP level of hospice care in last mo | 2.07 (1.92–2.26) | 2.93 (2.65–3.25) | 2.13 (1.94–2.33) | 3.02 (2.68–3.40) | 3.18 (2.80–3.61) |
|
| |||||
| Continuous hospice care in last mo | 2.41 (2.16–2.70) | 3.21 (2.80–3.67) | 2.37 (2.04–2.76) | 3.35 (2.89–3.89) | 4.24 (3.56–5.05) |
|
| |||||
| Nursing home stay in last 90 d | 0.98 (0.97–1.00) | 1.00 (0.99–1.02) | 1.05 (1.03–1.08) | 1.07 (1.05–1.09) | 1.01 (1.00–1.02) |
|
| |||||
| Hospitalization in last 90 d | 1.00 (0.99–1.01) | 1.11 (1.10–1.12) | 1.07 (1.06–1.08) | 1.02 (1.01–1.03) | 0.94 (0.93–0.95) |
|
| |||||
| ICU in last 30 d | 1.08 (1.07–1.10) | 1.23 (1.21–1.25) | 1.37 (1.33–1.41) | 1.12 (1.10–1.14) | 1.21 (1.18–1.25) |
|
| |||||
| Transitions | |||||
| Rate in the last 90 d, mean | 1.36 (1.34–1.37) | 1.48 (1.47–1.50) | 1.46 (1.44–1.48) | 1.42 (1.41–1.44) | 1.28 (1.27–1.30) |
|
| |||||
| Transition in last 3 d, % | 1.21 (1.19–1.23) | 1.36 (1.33–1.40) | 1.40 (1.35–1.46) | 1.39 (1.35–1.43) | 1.09 (1.06–1.12) |
|
| |||||
| ≤3 Hospitalizations in the last 90 d, % | 1.05 (1.03–1.08) | 1.14 (1.12–1.18) | 1.11 (1.07–1.15) | 1.10 (1.07–1.12) | 0.93 (0.89–0.97) |
|
| |||||
| Utilization measures | |||||
| Mechanical ventilation in last 30 d | 1.02 (1.01–1.04) | 1.16 (1.14–1.19) | 1.16 (1.11–1.22) | 1.02 (0.99–1.05) | 1.08 (1.02–1.13) |
|
| |||||
| Hospital days | |||||
| Last 30 d | 0.98 (0.95–0.97) | 0.96 (0.95–0.97) | 0.90 (0.88–0.92) | 0.89 (0.88–0.91) | 0.79 (0.78–0.81) |
|
| |||||
| Last 90 d | 1.01 (0.99–1.02) | 0.99 (0.97–1.00) | 0.90 (0.89–0.92) | 0.93 (0.91–0.95) | 0.83 (0.81–0.85) |
|
| |||||
| ICU days | |||||
| Last 30 d | 1.14 (1.11–1.17) | 1.28 (1.24–1.35) | 1.35 (1.29–1.42) | 1.12 (1.09–1.15) | 1.31 (1.25–1.38) |
|
| |||||
| Last 90 d | 1.20 (1.17–1.23) | 1.36 (1.32–1.40) | 1.41 (1.36–1.47) | 1.20 (1.17–1.24) | 1.39 (1.32–1.47) |
|
| |||||
| Hospice days | |||||
| Last 30 d | 1.51 (1.48–1.54) | 1.96 (1.90–2.02) | 1.20 (1.17–1.23) | 1.93 (1.87–2.00) | 2.94 (2.76–3.12) |
|
| |||||
| Last 90 d | 1.60 (1.55–1.64) | 2.31 (2.23–2.40) | 1.22 (1.19–1.26) | 2.09 (2.01–2.20) | 3.42 (3.21–3.65) |
Abbreviations: COPD, chronic obstructive pulmonary disease; GIP, general inpatient; ICU, intensive care unit; IRR, incidence rate ratio.
a
All sample sizes correspond to a random 20% sample of all fee-for-service Medicare decedents in each year.
b
Periods of time labeled as “last” refer to days before death.