Article

Cancer care in the United States: identifying end-of-life cohorts.

The Center for Healthcare Research and Reform, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Hanover, New Hampshire, USA.
Journal of palliative medicine (Impact Factor: 2.06). 03/2009; 12(2):128-32. DOI: 10.1089/jpm.2008.0239
Source: PubMed

ABSTRACT End-of-life care is increasingly recognized as an important part of cancer management for many patients. Current methods to measure end-of-life care are limited by difficulties in identifying cancer cohorts with administrative data. We examined several techniques of identifying end-of-life cancer cohorts with claims data that is population-based, geographically scalable, and amenable to routine updating.
Using Medicare claims for patients 65 years of age and older, four techniques for identifying end-of-life cancer cohorts were compared; one based on Part A data using a broad primary or narrow secondary diagnosis of cancer, two based on Part B data, and one combining the Part A and B methods. We tested the performance of each definition to ascertain an appropriate end-of-life cancer population.
The combined Part A and B definition using a primary or secondary diagnosis of cancer within a window of 180 days prior to death appears to be the most accurate and inclusive in ascertaining an end-of-life cohort (78.7% attainment).
Combining inpatient and outpatient claims data, and identifying cases based upon a broad primary or a narrow secondary cancer definition is the most accurate and inclusive in ascertaining an end-of-life cohort.

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