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Care Experiences of Managed Care Medicare Enrollees Near the End of Life

Identifieur interne : 001E95 ( Istex/Corpus ); précédent : 001E94; suivant : 001E96

Care Experiences of Managed Care Medicare Enrollees Near the End of Life

Auteurs : Marc N. Elliott ; Amelia M. Haviland ; Paul D. Cleary ; Alan M. Zaslavsky ; Donna O. Farley ; David J. Klein ; Carol A. Edwards ; Megan K. Beckett ; Nate Orr ; Debra Saliba

Source :

Journal of the American Geriatrics Society [ 0002-8614 ] ; 2013-03.

RBID : ISTEX:857D4CB3A9FA00ED9D38DF09B8E101F91E0F7D5D

English descriptors

Abstract

To compare reports about care experiences of individuals who died within 1 year of survey with reports of those who did not.

Url:

https://api.istex.fr/document/857D4CB3A9FA00ED9D38DF09B8E101F91E0F7D5D/fulltext/pdf

DOI: 10.1111/jgs.12121

Links to Exploration step

ISTEX:857D4CB3A9FA00ED9D38DF09B8E101F91E0F7D5D

Le document en format XML

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edicare Enrollees Near the End of Life</title>
<author xml:id="author-0000" role="corresp"><persName><forename type="first">Marc N.</forename>
<surname>Elliott</surname>
<roleName type="degree">PhD</roleName>
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<affiliation><orgName>RAND Corporation</orgName>
<address><settlement type="city">Santa Monica</settlement>
<region>California</region>
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<affiliation>Address correspondence to Marc N. Elliott, RAND, 1776 Main Street, Santa Monica, CA 90401. E‐mail: elliott@rand.org</affiliation>
</author>
<author xml:id="author-0001"><persName><forename type="first">Amelia M.</forename>
<surname>Haviland</surname>
<roleName type="degree">PhD</roleName>
</persName>
<affiliation><orgName>RAND Corporation</orgName>
<address><settlement type="city">Santa Monica</settlement>
<region>California</region>
</address>
</affiliation>
<affiliation><orgName>Heinz College</orgName>
<orgName>School of Public Policy & Management</orgName>
<orgName>Carnegie Mellon University</orgName>
<address><settlement type="city">Pittsburgh</settlement>
<region>Pennsylvania</region>
</address>
</affiliation>
</author>
<author xml:id="author-0002"><persName><forename type="first">Paul D.</forename>
<surname>Cleary</surname>
<roleName type="degree">PhD</roleName>
</persName>
<affiliation><orgName>Global Health</orgName>
<orgName>School of Public Health</orgName>
<orgName>Yale University</orgName>
<address><settlement type="city">New Haven</settlement>
<region>Connecticut</region>
</address>
</affiliation>
</author>
<author xml:id="author-0003"><persName><forename type="first">Alan M.</forename>
<surname>Zaslavsky</surname>
<roleName type="degree">PhD</roleName>
</persName>
<affiliation><orgName>Department of Health Care Policy</orgName>
<orgName>Harvard Medical School</orgName>
<address><settlement type="city">Boston</settlement>
<region>Massachusetts</region>
</address>
</affiliation>
</author>
<author xml:id="author-0004"><persName><forename type="first">Donna O.</forename>
<surname>Farley</surname>
<roleName type="degree">PhD, MPH</roleName>
</persName>
<affiliation><orgName>RAND Corporation</orgName>
<address><settlement type="city">Santa Monica</settlement>
<region>California</region>
</address>
</affiliation>
</author>
<author xml:id="author-0005"><persName><forename type="first">David J.</forename>
<surname>Klein</surname>
<roleName type="degree">MS</roleName>
</persName>
<affiliation><orgName>Department of Pediatrics</orgName>
<orgName>Children's Hospital Boston</orgName>
<address><settlement type="city">Boston</settlement>
<region>Massachusetts</region>
</address>
</affiliation>
</author>
<author xml:id="author-0006"><persName><forename type="first">Carol A.</forename>
<surname>Edwards</surname>
<roleName type="degree">PhD</roleName>
</persName>
<affiliation><orgName>RAND Corporation</orgName>
<address><settlement type="city">Santa Monica</settlement>
<region>California</region>
</address>
</affiliation>
</author>
<author xml:id="author-0007"><persName><forename type="first">Megan K.</forename>
<surname>Beckett</surname>
<roleName type="degree">PhD</roleName>
</persName>
<affiliation><orgName>RAND Corporation</orgName>
<address><settlement type="city">Santa Monica</settlement>
<region>California</region>
</address>
</affiliation>
</author>
<author xml:id="author-0008"><persName><forename type="first">Nate</forename>
<surname>Orr</surname>
<roleName type="degree">MA</roleName>
</persName>
<affiliation><orgName>RAND Corporation</orgName>
<address><settlement type="city">Santa Monica</settlement>
<region>California</region>
</address>
</affiliation>
</author>
<author xml:id="author-0009"><persName><forename type="first">Debra</forename>
<surname>Saliba</surname>
<roleName type="degree">MD, MPH</roleName>
</persName>
<affiliation><orgName>RAND Corporation</orgName>
<address><settlement type="city">Santa Monica</settlement>
<region>California</region>
</address>
</affiliation>
<affiliation><orgName>JH Borun Center for Gerontological Research</orgName>
<orgName>University of California at Los Angeles</orgName>
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<profileDesc><abstract style="main" xml:id="jgs12121-abs-0001">

Objectives
<p>To compare reports about care experiences of individuals who died within 1 year of survey with reports of those who did not.</p>


Design
<p>Medicare Advantage (<hi rend="fc">MA</hi>
) <hi rend="fc">C</hi>
onsumer <hi rend="fc">A</hi>
ssessment of <hi rend="fc">H</hi>
ealthcare <hi rend="fc">P</hi>
roviders and <hi rend="fc">S</hi>
ystems (<hi rend="fc">CAHPS</hi>
) surveys asked about care experiences. Survey completion dates were linked to <hi rend="fc">S</hi>
ocial <hi rend="fc">S</hi>
ecurity <hi rend="fc">A</hi>
dministration death records to identify enrollees dying within 1 year of survey completion. Propensity‐score weighting combined with regression‐based case‐mix adjustment was used to compare these individuals’ experiences with experiences of those who were alive 1 year later.</p>


Setting
<p>Nationally representative sample of <hi rend="fc">MA</hi>
 enrollees.</p>


Participants
<p>Four hundred two thousand five hundred ninety‐three <hi rend="fc">MA</hi>
 enrollees responding to 2008 and 2009 <hi rend="fc">CAHPS</hi>
 Surveys.</p>


Measurements
<p>Outcomes were five care ratings (plan, prescription drug coverage, doctor, specialists, care) and five composite measures of care (getting needed care, getting care quickly, doctor communication, getting drugs, getting drug information). Analyses were adjusted for age, sex, race and ethnicity, education, Medicaid status, geographic region, and several health status measures.</p>


Results
<p>Twelve thousand one hundred two enrollees (3%) died within 1 year of survey completion (near‐end‐of‐life group). Those enrollees reported slightly better experiences than other enrollees with respect to getting care quickly (+2%, <hi rend="italic">P</hi>
 < .001) and gave slightly higher ratings for their plans (+1%, <hi rend="italic">P</hi>
 = .02) and prescription drug coverage (+1%, <hi rend="italic">P</hi>
 < .001). There were no measures of participant experience for which the near‐end‐of‐life group reported worse experiences than other enrollees.</p>


Conclusion
<p>Contrary to analyses based on retrospective reports from surviving relatives after an individual's death, <hi rend="fc">MA</hi>
 enrollees’ reports about care within 1 year of death were as good as or better than reports of other <hi rend="fc">MA</hi>
 enrollees. Future research might investigate whether results are similar in other Medicare populations.</p>
</abstract>
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<creator affiliationRef="#jgs12121-aff-0001 #jgs12121-aff-0002" creatorRole="author" xml:id="jgs12121-cr-0002"><personName><givenNames>Amelia M.</givenNames>
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<creator affiliationRef="#jgs12121-aff-0004" creatorRole="author" xml:id="jgs12121-cr-0004"><personName><givenNames>Alan M.</givenNames>
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<creator affiliationRef="#jgs12121-aff-0001" creatorRole="author" xml:id="jgs12121-cr-0005"><personName><givenNames>Donna O.</givenNames>
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<creator affiliationRef="#jgs12121-aff-0005" creatorRole="author" xml:id="jgs12121-cr-0006"><personName><givenNames>David J.</givenNames>
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 <degrees>MS</degrees>
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 <degrees>PhD</degrees>
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 <degrees>MA</degrees>
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 <familyName>Saliba</familyName>
 <degrees>MD, MPH</degrees>
</personName>
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 <address><city>Santa Monica</city>
 <countryPart>California</countryPart>
</address>
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<affiliation type="organization" xml:id="jgs12121-aff-0002"><orgDiv>Heinz College</orgDiv>
 <orgDiv>School of Public Policy & Management</orgDiv>
 <orgName>Carnegie Mellon University</orgName>
 <address><city>Pittsburgh</city>
 <countryPart>Pennsylvania</countryPart>
</address>
</affiliation>
<affiliation type="organization" xml:id="jgs12121-aff-0003"><orgDiv>Global Health</orgDiv>
 <orgDiv>School of Public Health</orgDiv>
 <orgName>Yale University</orgName>
 <address><city>New Haven</city>
 <countryPart>Connecticut</countryPart>
</address>
</affiliation>
<affiliation type="organization" xml:id="jgs12121-aff-0004"><orgDiv>Department of Health Care Policy</orgDiv>
 <orgName>Harvard Medical School</orgName>
 <address><city>Boston</city>
 <countryPart>Massachusetts</countryPart>
</address>
</affiliation>
<affiliation type="organization" xml:id="jgs12121-aff-0005"><orgDiv>Department of Pediatrics</orgDiv>
 <orgName>Children's Hospital Boston</orgName>
 <address><city>Boston</city>
 <countryPart>Massachusetts</countryPart>
</address>
</affiliation>
<affiliation type="organization" xml:id="jgs12121-aff-0006"><orgDiv>JH Borun Center for Gerontological Research</orgDiv>
 <orgName>University of California at Los Angeles</orgName>
 <address><city>Los Angeles</city>
 <countryPart>California</countryPart>
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<abstractGroup><abstract type="main" xml:id="jgs12121-abs-0001"><section xml:id="jgs12121-sec-0001"><title type="main">Objectives</title>
<p>To compare reports about care experiences of individuals who died within 1 year of survey with reports of those who did not.</p>
</section>
<section xml:id="jgs12121-sec-0002"><title type="main">Design</title>
<p>Medicare Advantage (<fc>MA</fc>
) <fc>C</fc>
onsumer <fc>A</fc>
ssessment of <fc>H</fc>
ealthcare <fc>P</fc>
roviders and <fc>S</fc>
ystems (<fc>CAHPS</fc>
) surveys asked about care experiences. Survey completion dates were linked to <fc>S</fc>
ocial <fc>S</fc>
ecurity <fc>A</fc>
dministration death records to identify enrollees dying within 1 year of survey completion. Propensity‐score weighting combined with regression‐based case‐mix adjustment was used to compare these individuals’ experiences with experiences of those who were alive 1 year later.</p>
</section>
<section xml:id="jgs12121-sec-0003"><title type="main">Setting</title>
<p>Nationally representative sample of <fc>MA</fc>
 enrollees.</p>
</section>
<section xml:id="jgs12121-sec-0004"><title type="main">Participants</title>
<p>Four hundred two thousand five hundred ninety‐three <fc>MA</fc>
 enrollees responding to 2008 and 2009 <fc>CAHPS</fc>
 Surveys.</p>
</section>
<section xml:id="jgs12121-sec-0005"><title type="main">Measurements</title>
<p>Outcomes were five care ratings (plan, prescription drug coverage, doctor, specialists, care) and five composite measures of care (getting needed care, getting care quickly, doctor communication, getting drugs, getting drug information). Analyses were adjusted for age, sex, race and ethnicity, education, Medicaid status, geographic region, and several health status measures.</p>
</section>
<section xml:id="jgs12121-sec-0006"><title type="main">Results</title>
<p>Twelve thousand one hundred two enrollees (3%) died within 1 year of survey completion (near‐end‐of‐life group). Those enrollees reported slightly better experiences than other enrollees with respect to getting care quickly (+2%, <i>P</i>
 < .001) and gave slightly higher ratings for their plans (+1%, <i>P</i>
 = .02) and prescription drug coverage (+1%, <i>P</i>
 < .001). There were no measures of participant experience for which the near‐end‐of‐life group reported worse experiences than other enrollees.</p>
</section>
<section xml:id="jgs12121-sec-0007"><title type="main">Conclusion</title>
<p>Contrary to analyses based on retrospective reports from surviving relatives after an individual's death, <fc>MA</fc>
 enrollees’ reports about care within 1 year of death were as good as or better than reports of other <fc>MA</fc>
 enrollees. Future research might investigate whether results are similar in other Medicare populations.</p>
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<originInfo><publisher>Blackwell Publishing Ltd</publisher>
<dateIssued encoding="w3cdtf">2013-03</dateIssued>
<dateCreated encoding="w3cdtf">2012-12-13</dateCreated>
<copyrightDate encoding="w3cdtf">2013</copyrightDate>
</originInfo>
<language><languageTerm type="code" authority="rfc3066">en</languageTerm>
<languageTerm type="code" authority="iso639-2b">eng</languageTerm>
</language>
<abstract>To compare reports about care experiences of individuals who died within 1 year of survey with reports of those who did not.</abstract>
<abstract>Medicare Advantage (MA) Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys asked about care experiences. Survey completion dates were linked to Social Security Administration death records to identify enrollees dying within 1 year of survey completion. Propensity‐score weighting combined with regression‐based case‐mix adjustment was used to compare these individuals’ experiences with experiences of those who were alive 1 year later.</abstract>
<abstract>Nationally representative sample of MA enrollees.</abstract>
<abstract>Four hundred two thousand five hundred ninety‐three MA enrollees responding to 2008 and 2009 CAHPS Surveys.</abstract>
<abstract>Outcomes were five care ratings (plan, prescription drug coverage, doctor, specialists, care) and five composite measures of care (getting needed care, getting care quickly, doctor communication, getting drugs, getting drug information). Analyses were adjusted for age, sex, race and ethnicity, education, Medicaid status, geographic region, and several health status measures.</abstract>
<abstract>Twelve thousand one hundred two enrollees (3%) died within 1 year of survey completion (near‐end‐of‐life group). Those enrollees reported slightly better experiences than other enrollees with respect to getting care quickly (+2%, P < .001) and gave slightly higher ratings for their plans (+1%, P = .02) and prescription drug coverage (+1%, P < .001). There were no measures of participant experience for which the near‐end‐of‐life group reported worse experiences than other enrollees.</abstract>
<abstract>Contrary to analyses based on retrospective reports from surviving relatives after an individual's death, MA enrollees’ reports about care within 1 year of death were as good as or better than reports of other MA enrollees. Future research might investigate whether results are similar in other Medicare populations.</abstract>
<note type="funding">Centers for Medicare and Medicaid Services Contract - No. HHSM‐500–2005–00028I; </note>
<subject><genre>keywords</genre>
<topic>end of life</topic>
<topic>patient experience</topic>
<topic>Medicare</topic>
</subject>
<relatedItem type="host"><titleInfo><title>Journal of the American Geriatrics Society</title>
</titleInfo>
<titleInfo type="abbreviated"><title>J Am Geriatr Soc</title>
</titleInfo>
<genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre>
<subject><genre>article-category</genre>
<topic>Brief Reports</topic>
</subject>
<identifier type="ISSN">0002-8614</identifier>
<identifier type="eISSN">1532-5415</identifier>
<identifier type="DOI">10.1111/(ISSN)1532-5415</identifier>
<identifier type="PublisherID">JGS</identifier>
<part><date>2013</date>
<detail type="volume"><caption>vol.</caption>
<number>61</number>
</detail>
<detail type="issue"><caption>no.</caption>
<number>3</number>
</detail>
<extent unit="pages"><start>407</start>
<end>412</end>
<total>6</total>
</extent>
</part>
</relatedItem>
<identifier type="istex">857D4CB3A9FA00ED9D38DF09B8E101F91E0F7D5D</identifier>
<identifier type="ark">ark:/67375/WNG-V37CW6GX-Q</identifier>
<identifier type="DOI">10.1111/jgs.12121</identifier>
<identifier type="ArticleID">JGS12121</identifier>
<accessCondition type="use and reproduction" contentType="copyright">© 2013 American Geriatrics Society and Wiley Periodicals, Inc.© 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society</accessCondition>
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Care Experiences of Managed Care Medicare Enrollees Near the End of Life

Care Experiences of Managed Care Medicare Enrollees Near the End of Life

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