Megan A Mullins1, Julie J Ruterbusch2, Philippa Clarke3, Shitanshu Uppal4, Michele L Cote2, Lauren P Wallner5. 1. Center for Improving Patient and Population Health and Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States of America. Electronic address: mamull@umich.edu. 2. Wayne State University School of Medicine and Karmanos Cancer Institute, Detroit, MI, United States of America. 3. Department of Epidemiology and Institute for Social Research, University of Michigan, Ann Arbor, MI, United States of America. 4. Department of Gynecologic Oncology, University of Michigan, Ann Arbor, MI, United States of America. 5. Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States of America.
Abstract
OBJECTIVE: To evaluate the association between post-diagnosis continuity of care and receipt of aggressive end of life care among women dying of ovarian cancer. METHODS: This retrospective claims analysis included 6680 Medicare beneficiaries over age 66 with ovarian cancer who survived at least one year after diagnosis, had at least 4 outpatient evaluation and management visits and died between 2000 and 2016. We calculated the Bice-Boxerman Continuity of Care Index (COC) for each woman, and split COC into tertiles (high, medium, low). We compared late or no hospice use, >1 emergency department (ED) visit, intensive care unit (ICU) admission, >1 hospitalization, terminal hospitalization, chemotherapy, and invasive and/or life extending procedures among women with high or medium vs. low COC using multivariable adjusted logistic regression. RESULTS: In this sample, 49.8% of women received aggressive care in the last month of life. Compared to women with low COC, women with high COC had 66% higher odds of chemotherapy (adjusted OR 1.66 CI 1.23-2.24) in the last two weeks of life. Women with high COC also had 16% greater odds of not enrolling in hospice compared to women with low COC (adjusted OR 1.16 CI 1.01-1.33). COC was not associated with late enrollment in hospice, hospital utilization, or aggressive procedures. CONCLUSIONS: COC at the end of life is complicated and may pose unique challenges in providing quality end of life care. Future work exploring the specific facets of continuity associated with quality end of life care is needed.
OBJECTIVE: To evaluate the association between post-diagnosis continuity of care and receipt of aggressive end of life care among women dying of ovarian cancer. METHODS: This retrospective claims analysis included 6680 Medicare beneficiaries over age 66 with ovarian cancer who survived at least one year after diagnosis, had at least 4 outpatient evaluation and management visits and died between 2000 and 2016. We calculated the Bice-Boxerman Continuity of Care Index (COC) for each woman, and split COC into tertiles (high, medium, low). We compared late or no hospice use, >1 emergency department (ED) visit, intensive care unit (ICU) admission, >1 hospitalization, terminal hospitalization, chemotherapy, and invasive and/or life extending procedures among women with high or medium vs. low COC using multivariable adjusted logistic regression. RESULTS: In this sample, 49.8% of women received aggressive care in the last month of life. Compared to women with low COC, women with high COC had 66% higher odds of chemotherapy (adjusted OR 1.66 CI 1.23-2.24) in the last two weeks of life. Women with high COC also had 16% greater odds of not enrolling in hospice compared to women with low COC (adjusted OR 1.16 CI 1.01-1.33). COC was not associated with late enrollment in hospice, hospital utilization, or aggressive procedures. CONCLUSIONS: COC at the end of life is complicated and may pose unique challenges in providing quality end of life care. Future work exploring the specific facets of continuity associated with quality end of life care is needed.
Authors: Craig C Earle; Elyse R Park; Bonnie Lai; Jane C Weeks; John Z Ayanian; Susan Block Journal: J Clin Oncol Date: 2003-03-15 Impact factor: 44.544
Authors: Craig C Earle; Bridget A Neville; Mary Beth Landrum; John Z Ayanian; Susan D Block; Jane C Weeks Journal: J Clin Oncol Date: 2004-01-15 Impact factor: 44.544
Authors: Akiko M Saito; Mary Beth Landrum; Bridget A Neville; John Z Ayanian; Craig C Earle Journal: BMC Palliat Care Date: 2011-09-21 Impact factor: 3.234