1 Department of Health Policy and Management, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.
2 Department of Statistical Sciences, Duke University School of Medicine , Durham, North Carolina.
J Palliat Med. 2018 Aug;21(8):1131-1136. doi: 10.1089/jpm.2018.0039. Epub 2018 May 15.
Use of the Medicare hospice benefit has been associated with high-quality care at the end of life, and hospice length of use in particular has been used as a proxy for appropriate timing of hospice enrollment. Quantile regression has been underutilized as an alternative tool to model distributional changes in hospice length of use and hospice payments outside of the mean.
To test for heterogeneity in the relationship between patient characteristics and hospice outcomes across the distribution of hospice days.
Medicare Beneficiary Summary File and survey data (2014) for hospice beneficiaries in North and South Carolina with common terminal diagnoses.
Distributional shifts associated with patient characteristics were evaluated at the 25th and 75th percentiles of hospice days and hospice payments using quantile regressions and compared to the mean shift estimated by ordinary least squares (OLS) regression.
Significant (p < 0.001) heterogeneity in the marginal effects on hospice days and costs was observed, with patient characteristics associated with generally larger shifts in the 75th percentile than the 25th percentile. Mean effects estimated by OLS regression overestimate the magnitude of the median marginal effects for all patient characteristics except for race. Results for hospice payments in 2014 were similar.
Methodological decisions can have a meaningful impact in the evaluation of factors influencing hospice length of use or cost.
使用医疗保险临终关怀福利与临终关怀质量相关，特别是临终关怀的使用时间已被用作适当的临终关怀登记时间的代理指标。分位数回归作为一种替代工具，用于模型化临终关怀使用时间和临终关怀支付的分布变化，尚未得到充分利用，而这些变化超出了平均值。
测试患者特征与临终关怀结果之间的关系在临终关怀天数分布上的异质性。
北卡罗来纳州和南卡罗来纳州的医疗保险受益人摘要文件和调查数据（2014 年），针对具有常见终末诊断的临终关怀受益人。
使用分位数回归在临终关怀天数和临终关怀支付的 25%和 75%分位数处评估与患者特征相关的分布转移，并与普通最小二乘法（OLS）回归估计的平均转移进行比较。
观察到患者特征对临终关怀天数和成本的边际效应存在显著（p<0.001）异质性，与患者特征相关的转移通常在 75%分位数大于 25%分位数。OLS 回归估计的平均效应高估了所有患者特征（除种族外）的中位数边际效应的幅度。2014 年的临终关怀支付结果类似。
方法学决策会对评估影响临终关怀使用时间或成本的因素产生有意义的影响。
