South Carolina Rural Health Research Center and Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.
Department of Health Services Policy and Management, South Carolina Rural Health Research Center and Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.
J Pain Symptom Manage. 2017 Nov;54(5):661-669. doi: 10.1016/j.jpainsymman.2017.06.002. Epub 2017 Jul 25.
Inpatient hospitalizations are a driver of expenditures at the end of life and are a useful proxy for the intensity of care at that time.
Our study profiled rural and urban Medicare decedents to examine whether they differed in rates of inpatient hospital admissions in the last six months of life.
Using a sample of 35,831 beneficiaries from the 2013 Medicare Research Identifiable Files, we examined inpatient hospital utilization patterns for a full six months before death. Supply-side variables included the number of hospital beds, certified skilled nursing facility beds, and hospice beds per 1000 residents, plus primary care provider/population ratios. Patient characteristics included age, sex, race/ethnicity, dual eligibility status, region, and chronic conditions.
In both adjusted and unadjusted analysis, rural vs. urban residence was not associated with an increased risk for hospitalization at the end of life among Medicare beneficiaries nor was there a relationship between the supply of hospital, skilled nursing, and hospice services and the rate of hospitalization. Within rural residents alone, modest effects were found for facility supply. Rural residents in a county without a hospital were slightly less likely than other rural decedents to have been hospitalized during their last six months of life but were no less likely to have used skilled nursing facilities or hospice.
The absence of major disparities in utilization suggests that end-of-life care is reasonably equitable for rural Medicare beneficiaries.
住院治疗是生命末期支出的驱动因素，也是当时护理强度的有用指标。
我们的研究对农村和城市的医疗保险死者进行了分析，以检查他们在生命的最后六个月内住院率是否存在差异。
使用来自 2013 年医疗保险研究可识别文件的 35831 名受益人的样本，我们检查了死亡前整整六个月的住院利用模式。供应方变量包括每千名居民的医院床位、认证的熟练护理设施床位和临终关怀床位数量，以及初级保健提供者/人口比例。患者特征包括年龄、性别、种族/民族、双重资格状况、地区和慢性疾病。
在调整和未调整分析中，与农村相比，农村居民与医疗保险受益人生命末期住院风险增加无关，医院、熟练护理和临终关怀服务的供应与住院率之间也没有关系。仅在农村居民中，设施供应就存在适度的影响。在没有医院的县的农村居民在生命的最后六个月住院的可能性略低于其他农村死者，但使用熟练护理设施或临终关怀的可能性并不低。
利用方面没有出现重大差异，这表明农村医疗保险受益人的临终关怀相当公平。
