title: Hospice care and resource utilization in Medicare beneficiaries with heart failure.
abstract: BACKGROUND
  Although hospice use may be increasing among heart failure patients, its association with both cost and intensity of care in this population has not been well examined.
  
  
  OBJECTIVE
  To assess the association of hospice care with resource utilization among a national sample of Medicare beneficiaries with heart failure during the last 6 months of life.
  
  
  METHODS
  We performed a cross-sectional analysis of the 5% sample of Medicare claims data. Negative binomial regression models were used to compare expenditures, hospitalization rates, and intensive care unit (ICU) days between hospice and nonhospice beneficiaries. We used Poisson regression models to compare utilization of certain procedures between hospice and nonhospice beneficiaries.
  
  
  RESULTS
  Among 16613 Medicare beneficiaries who died with heart failure in 2007, 6436 (38.7%) received hospice care during the last 6 months of life. The mean total medical expenditures were $31,793 (SD 25,691) among decedents with hospice care, in comparison to $34,067 (SD 40,561) among decedents without hospice care. However, after adjustments for covariates, hospice care was associated with 4% higher expenditures (cost ratio, 1.04; 95% confidence interval, CI: 1.01-1.07). Hospice use was associated with reduced hospitalizations (adjusted incidence rate ratio, 0.87, 95% CI: 0.84-0.89), ICU days (adjusted incidence rate ratio, 0.68, 95% CI: 0.63-0.73), and procedures, including cardiac catheterization, noninvasive ventilation, and mechanical ventilation.
  
  
  CONCLUSIONS
  Despite lower rates of hospitalization, ICU days, and invasive procedures, hospice care was not associated with reduced expenditures in heart failure. Financial savings related to reduced intensive medical care seems to be offset by the expenditures related to hospice care itself.
authors: Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. saul.blecker@nyumc.org
authors: Saul
authors: S
authors: Blecker
authors: Gerard F
authors: GF
authors: Anderson
authors: Robert
authors: R
authors: Herbert
authors: Nae-Yuh
authors: NY
authors: Wang
authors: Frederick L
authors: FL
authors: Brancati
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003422:Critical Care / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005102:Health Expenditures; D006333:Heart Failure / Q000191:economics / Q000628:therapy*; D017051:Hospice Care / Q000191:economics / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data*; D016012:Poisson Distribution; D012044:Regression Analysis; D014481:United States