Table 2.

End-of-Life Care in HRRs by Quartile of Primary Care Involvement in the Last 6 Months of Life

	Quartile of HRRs by Ratio of Primary Care to Specialist Visits in the Last 6 Months of Life
Measure	First (Least PCP Involvement) (n = 76)	Second (n = 76)	Third (n = 76)	Fourth (Most PCP Involvement) (n = 77)	P Valuea
Deaths occurring in hospitals, % (95% CI)	24.5 (23.8–25.1)	24.0 (23.5–24.5)	24.0 (23.5–24.5)	24.0 (23.4–24.6)	.55
Decedents enrolled in hospice, % (95% CI)	50.4 (49.1–51.7)	48.1 (47.2–49.1)	47.9 (46.9–48.9)	44.5 (43.3–45.7)	.004
Patients seeing ≥10 physicians in their last 6 mo of life, % (95% CI)	42.4 (41.6–43.1)	37.8 (37.2–38.4)	36.9 (36.3–37.6)	37.0 (36.3–37.8)	<.001
Patients receiving ICU care during their final hospital admission, % (95% CI)	17.5 (17.0–17.9)	15.9 (15.5–16.2)	15.2 (14.9–15.6)	14.5 (14.1–14.9)	<.001
Hospital days in the last 6 mo of life, No. (95% CI)	9.76 (9.57–9.96)	9.10 (8.95–9.25)	9.00 (8.84–9.15)	9.15 (8.97–9.33)	.10
ICU days in the last 6 mo of life, No. (95% CI)	4.29 (4.13–4.44)	3.63 (3.51–3.75)	3.07 (2.95–3.20)	2.90 (2.76–3.05)	<.001
Total Medicare spending per decedent in last 2 y of life, US$1,000b	69.03 (68.08–69.98)	66.70 (65.96–67.44)	64.07 (63.32–64.83)	65.16 (64.27–66.05)	.003

HRR = hospital referral region; ICU = intensive care unit; PCP = primary care physician.

Note: Adjusted for the HRR percentage of population below the federal poverty limit, percentage of Medicare beneficiaries reporting they were African American, percentage of beneficiaries who were female, average age of Medicare beneficiaries, average hierarchical condition category score of Medicare beneficiaries, percentage of HRR that is urban, obesity rate, stroke rate, and regional density of specialist physicians.

^aTesting the ratio of primary care to specialist visits as a continuous variable as opposed to quartiles of the ratio.

^bIn 2010 dollars.