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Deprecated: Implicit conversion from float 217.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 J+Am+Geriatr+Soc 2016 ; 64 (5): 1061-7 Nephropedia Template TP
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How U S Doctors Die: A Cohort Study of Health Care Utilization at End of Life #MMPMID27195936
Matlock DD; Yamashita TE; Sung-Joon M; Smith AK; Kelley AS; Fischer S
J Am Geriatr Soc 2016[May]; 64 (5): 1061-7 PMID27195936show ga
Objectives: We aimed to compare health care utilization in the last months of life between physicians and non-physicians in the United States (US). Based on widely publicized testimonial and hypothetical evidence stating that physicians desire less aggressive care at the end of life, we hypothesized that physicians would spend fewer days in the hospital and more days in hospice at the end of life when compared to non-physicians. Design: A retrospective observational cohort study. Methods: Fee-for-service Medicare beneficiaries across the United States using Medicare Part A claims data from 2008?2010 for decedent physicians (N=9947) and a random sample of Medicare decedents (N=192,006). Utilization measured by days in the hospital and proportion utilizing hospice in the last six months of life as primary outcome measures adjusted for sociodemographic characteristics and regional variations in health care. Results: Inpatient hospital utilization in the last 6 months of life was no different between physicians and non-physicians, although more physicians used hospice and for longer. Comparisons of physicians to others, adjusting for covariates, were: 1) utilizing the hospital (OR=0.98, 95% CI 0.93 to 1.04); 2) hospital days (mean difference 0.26, P=0.14); 3) dying in the hospital (OR=0.99, 95% CI 0.95 to 1.04) 4) ICU/CCU days (mean difference 0.35 more days for physicians, P<0.001); 5) using hospice (OR=1.23, 95% CI 1.18 to 1.29); 6) number of days in hospice (mean difference 2.06 P<0.001). Conclusion: This retrospective, observational study is subject to unmeasured confounders and variation in coding practices. However, this study provides preliminary evidence of actual utilization. US Physicians were more likely to use hospice and ICU/CCU level care. Hospitalization rates were similar.