Table 4.
Adjusted Medicare Expenditures: Residents with Palliative Care (PC) in Differing Time Periods and Their Matched Controlsa,b
| Outcomes |
With PC Consult Adjusted Expenditures, (95% CI) |
Without PC Consult Adjusted Expenditures, (95% CI) |
P-value |
|---|---|---|---|
| Expenditures in last 7 days of life | |||
| Days between death and initial PC visit | |||
| ≤ 7 daysc | 6365 (5997 to 6734) | 9243 (8708 to 9778) | <.001 |
| 8–30 days | 4414 (4249 to 4579) | 5028 (4841 to 5216) | .117d |
| 31–60 days | 4662 (4395 to 4929) | 5042 (4754 to 5331) | .525 |
| 61–180 days | 3097 (2926 to 3267) | 4140 (3912 to 4367) | .008 |
| Expenditures in last 30 days of life | |||
| Days between death and initial PC visit | |||
| 31–60 days | 9784 (9241 to 10327) | 9012 (8512 to 9511) | .416 |
| 61–180 days | 7000 (6609 to 7390) | 7000 (6610 to 7390) | 1.000 |
| Expenditures in last 60 days of life | |||
| Days between death and initial PC visit | |||
| 61–180 days | 12151 (11443 to 12858) | 11496 (10827 to 12166) | .528 |
Abbreviations: PC, palliative care
Adjusted rates based on multivariate models controlling for the following variables, unless otherwise noted: For Residents: at baseline, age, marital status, non-White, do-not-resuscitate order, do-not-hospitalize order, 4-category dementia/cancer diagnoses, activities of daily living impairment, cognitive impairment, stability of cognition and functioning; days between baseline assessment and death; 1 or 2 or more hospitalizations in the 90 days prior to baseline assessment and year of death. For nursing homes: percent non-White, resident casemix, chain affiliation, profit status, employment of any nurse practitioner and/or physician assistant, proportion of residents on Medicare or Medicaid as primary payer, distance between nursing home and nearest hospital; and, location of nursing home (Rhode Island or North Carolina).
Values represent US dollars standardized to 2007 values.
Models did not include non-White, percent non-White, and 2 or more hospitalizations in 90 days prior to baseline assessment.
P-values do not perfectly coincide with 95% CI because p-values were generated from the predicted probabilities while the p-value was taken from the palliative consult estimate of the multivariate model.