Carolyn J Presley1, Kiranveer Kaur1, Ling Han2, Pamela R Soulos2,3, Weiwei Zhu2,3, Emily Corneau4, John R O'Leary2, Herta Chao2,5, Tracy Shamas5, Michal G Rose2,5, Karl A Lorenz6,7, Cari R Levy8, Vincent Mor4,9, Cary P Gross2,3,10. 1. Division of Medical Oncology, The Ohio State University, Columbus, Ohio, USA. 2. Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA. 3. Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut, USA. 4. Center of Innovation, Providence Veterans Health Administration (VA) Medical Center, Providence, Rhode Island, USA. 5. Connecticut Veterans Health Administration, West Haven, Connecticut, USA. 6. Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, California, USA. 7. School of Medicine, Stanford University, Stanford, California, USA. 8. Eastern Colorado VA Healthcare System, Aurora, Colorado, USA. 9. Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA. 10. National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut, USA.
Abstract
Background: Unlike fee-for-service Medicare, the Veterans Health Administration (VHA) allows for the provision of concurrent care, incorporating cancer treatment while in hospice. Methods: We compared trends of aggressive care at end of life between Medicare and VHA decedents with advanced nonsmall cell lung cancer from 2006 to 2012, and the relation between regional level end-of-life care between Medicare and VHA beneficiaries. Results: Among 18,371 Veterans and 25,283 Medicare beneficiaries, aggressive care at end of life decreased 15% in VHA and 4% in SEER (Surveillance, Epidemiology, and End Results)-Medicare (p < 0.001). Hospice use significantly increased within both cohorts (VHA 28%-41%; SM 60%-73%, p < 0.001). Veterans receiving care in regions with higher hospice admissions among Medicare beneficiaries were significantly less likely to receive aggressive care at end of life (adjusted odds ratio: 0.13, 95% confidence interval: 0.08-0.23, p < 0.001). Conclusions: Patients receiving lung cancer care in the VHA had a greater decline in aggressive care at end of life, perhaps due to increasing concurrent care availability.
Background: Unlike fee-for-service Medicare, the Veterans Health Administration (VHA) allows for the provision of concurrent care, incorporating cancer treatment while in hospice. Methods: We compared trends of aggressive care at end of life between Medicare and VHA decedents with advanced nonsmall cell lung cancer from 2006 to 2012, and the relation between regional level end-of-life care between Medicare and VHA beneficiaries. Results: Among 18,371 Veterans and 25,283 Medicare beneficiaries, aggressive care at end of life decreased 15% in VHA and 4% in SEER (Surveillance, Epidemiology, and End Results)-Medicare (p < 0.001). Hospice use significantly increased within both cohorts (VHA 28%-41%; SM 60%-73%, p < 0.001). Veterans receiving care in regions with higher hospice admissions among Medicare beneficiaries were significantly less likely to receive aggressive care at end of life (adjusted odds ratio: 0.13, 95% confidence interval: 0.08-0.23, p < 0.001). Conclusions: Patients receiving lung cancer care in the VHA had a greater decline in aggressive care at end of life, perhaps due to increasing concurrent care availability.
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