title: Dartmouth Atlas Area-Level Estimates of End-of-Life Expenditures: How Well Do They Reflect Expenditures for Prospectively Identified Advanced Lung Cancer Patients?
abstract: OBJECTIVE
  Assess validity of the retrospective Dartmouth hospital referral region (HRR) end-of-life spending measures by comparing with health care expenditures from diagnosis to death for prospectively identified advanced lung cancer patients.
  We calculated health care spending from diagnosis (2003-2005) to death or through 2011 for 885 patients aged ≥65 years with advanced lung cancer using Medicare claims. We assessed the association between Dartmouth HRR-level spending in the last 2 years of life and patient-level spending using linear regression with random HRR effects, adjusting for patient characteristics.
  
  
  RESULTS
  For each $1 increase in the Dartmouth metric, spending for our cohort increased by $0.74 (p < .001). The Dartmouth spending variable explained 93.4 percent of the HRR-level variance in observed spending.
  
  
  CONCLUSIONS
  HRR-level spending estimates for deceased patient cohorts reflect area-level care intensity for prospectively identified advanced lung cancer patients.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA.|Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Keating
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Landrum
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors.forename: Haiden A
authors.initials: HA
authors.lastname: Huskamp
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors.forename: Elena M
authors.initials: EM
authors.lastname: Kouri
authors.affiliation: Center for Research on End-of-Life Care, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY.
authors.forename: Holly G
authors.initials: HG
authors.lastname: Prigerson
authors.affiliation: Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Schrag
authors.affiliation: Department of Radiology, Weill Cornell Medical College, New York, NY.
authors.forename: Paul K
authors.initials: PK
authors.lastname: Maciejewski
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, OR.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Hornbrook
authors.affiliation: VA HSR&D Center for Health Information and Communication, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: David A
authors.initials: DA
authors.lastname: Haggstrom
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics* / Q000401:mortality; D008297:Male; D006278:Medicare / Q000191:economics*; D011446:Prospective Studies; D012189:Retrospective Studies; D013727:Terminal Care / Q000191:economics*; D014481:United States
keywords: Variation; health care expenditures; lung cancer