title: Variation in Intensity and Costs of Care by Payer and Race for Patients Dying of Cancer in Texas: An Analysis of Registry-linked Medicaid, Medicare, and Dually Eligible Claims Data.
abstract: OBJECTIVE
  To investigate end-of-life care for Medicaid, Medicare, and dually eligible beneficiaries dying of cancer in Texas.
  
  
  METHODS
  We analyzed the Texas Cancer Registry (TCR)-Medicaid and TCR-Medicare linked databases' claims data for 69,572 patients dying of cancer in Texas from 2000 to 2008. We conducted regression models in adjusted analyses of cancer-directed and acute care and total costs of care (in 2014 dollars) in the last 30 days of life.
  
  
  RESULTS
  Medicaid patients were more likely to receive chemotherapy and radiation therapy. Medicaid patients were more likely to have >1 emergency room (ER) [odds ratio (OR)=5.27; 95% confidence interval (CI), 4.76-5.84], and were less likely to enroll in hospice (OR=0.59; 95% CI, 0.55-0.63) than Medicare patients. Dual eligibles were more likely to have >1 ER visit than Medicare-only beneficiaries (OR=1.19; 95% CI, 1.07-1.33). Black and Hispanic patients were more likely to experience >1 ER visit and >1 hospitalization than whites. Costs were higher for nonwhite Medicare, Medicaid, and dually eligible patients compared with white Medicare enrollees.
  
  
  CONCLUSIONS
  Variation in acute care utilization and costs by race and payer suggest efforts are needed to address palliative care coordination at the end of life for Medicaid and dually eligible beneficiaries and minority patients dying of cancer.
authors.affiliation: Departments of *Radiation Oncology †Health Services Research ‡Breast Medical Oncology, MD Anderson Cancer Center, Houston, TX.
authors.forename: B Ashleigh
authors.initials: BA
authors.lastname: Guadagnolo
authors.forename: Kai-Ping
authors.initials: KP
authors.lastname: Liao
authors.forename: Sharon H
authors.initials: SH
authors.lastname: Giordano
authors.forename: Linda S
authors.initials: LS
authors.lastname: Elting
authors.forename: Ya-Chen T
authors.initials: YC
authors.lastname: Shih
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017048:Health Care Costs; D006302:Health Services Research; D006801:Humans; D008297:Male; D008484:Medicaid / Q000191:economics*; D006278:Medicare / Q000191:economics*; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics* / Q000208:ethnology* / Q000401:mortality / Q000628:therapy*; D012042:Registries; D013727:Terminal Care / Q000191:economics*; D013781:Texas / Q000453:epidemiology; D014481:United States