Qualitative analysis of Medicare claims in the last 3 years of life: a pilot study.
OBJECTIVE
To study end-of-life care of a representative sample of older people using qualitative interpretation of administrative claims by clinicians and to explore whether this method yields insights into patient care, including continuity, errors, and cause of death.


METHODS
Random, stratified sampling of decedents and all their Medicare-covered healthcare claims in the 3 years before death from a 5% sample of elderly fee-for-service beneficiaries, condensation of all claims into a chronological clinical summary, and abstraction by two independent clinicians using a standardized form.


METHODS
United States.


METHODS
One hundred Medicare fee-for-service older people without disability or end-stage renal disease entitlement who died in 1996 to 1999 and had at least 36 months of continuous Part A and Part B enrollment before death.


METHODS
Qualitative narrative of the patient's medical course; clinician assessment of care continuity and apparent medical errors; cause, trajectory, and place of death.


RESULTS
The qualitative narratives developed by the independent abstracters were highly concordant. Clinicians felt that 75% of cases lacked continuity of care that could have improved the quality of life and the way the person died, and 13% of cases had a medical error identified by both abstracters. Abstracters disagreed about assignment of a single cause of death in 28% of cases, and abstracters and the computer algorithm disagreed in 43% of cases.


CONCLUSIONS
Qualitative claims analysis illuminated many problems in the care of chronically ill older people at the end of life and suggested that traditional vital statistics assignation of a single cause of death may distort policy priorities. This novel approach to claims review is feasible and deserves further study.
Barnato
Amber E
AE
University of Pittsburgh, Pittsburgh, Pennsylvania, USA. barnatoae@upmc.edu <barnatoae@upmc.edu>
Labor
Renee E
RE
Freeborne
Nancy E
NE
Jayes
Robert L
RL
Campbell
Diane E
DE
Lynn
Joanne
J
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003266:Continuity of Patient Care; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data; D005260:Female; D006291:Health Policy; D006299:Health Services for the Aged / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data*; D011788:Quality of Life; D013727:Terminal Care / Q000191:economics / Q000706:statistics & numerical data*