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.
↵a Testing the ratio of primary care to specialist visits as a continuous variable as opposed to quartiles of the ratio.
↵b In 2010 dollars.