title: Care experiences of managed care Medicare enrollees near the end of life.
abstract: OBJECTIVE
  To compare reports about care experiences of individuals who died within 1 year of survey with reports of those who did not.
  
  
  METHODS
  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.
  
  
  METHODS
  Nationally representative sample of MA enrollees.
  
  
  METHODS
  Four hundred two thousand five hundred ninety-three MA enrollees responding to 2008 and 2009 CAHPS Surveys.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: RAND Corporation, Santa Monica, CA 90401, USA. elliott@rand.org
authors: Marc N
authors: MN
authors: Elliott
authors: Amelia M
authors: AM
authors: Haviland
authors: Paul D
authors: PD
authors: Cleary
authors: Alan M
authors: AM
authors: Zaslavsky
authors: Donna O
authors: DO
authors: Farley
authors: David J
authors: DJ
authors: Klein
authors: Carol A
authors: CA
authors: Edwards
authors: Megan K
authors: MK
authors: Beckett
authors: Nate
authors: N
authors: Orr
authors: Debra
authors: D
authors: Saliba
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000628:therapy*; D003953:Diagnosis-Related Groups; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D016014:Linear Models; D008297:Male; D008329:Managed Care Programs; D020398:Medicare Part C; D017060:Patient Satisfaction; D057216:Propensity Score; D013727:Terminal Care; D014481:United States