title: How U.S. Doctors Die: A Cohort Study of Healthcare Use at the End of Life.
abstract: To compare healthcare use in the last months of life between physicians and nonphysicians in the United States.
  
  
  
  A retrospective observational cohort study.
  
  
  
  United States.
  
  
  
  Fee-for-service Medicare beneficiaries: decedent physicians (n = 9,947) and a random sample of Medicare decedents (n = 192,006).
  
  
  
  Medicare Part A claims data from 2008 to 2010 were used to measure days in the hospital and proportion using hospice in the last 6 months of life as primary outcome measures adjusted for sociodemographic characteristics and regional variations in health care.
  
  
  
  Inpatient hospital use in the last 6 months of life was no different between physicians and nonphysicians, although more physicians used hospice and for longer (using the hospital: odds ratio (OR) = 0.98, 95% confidence interval (CI) = 0.93-1.04; hospital days: mean difference 0.26, P = .14); dying in the hospital: OR = 0.99, 95% CI = 0.95-1.04; intensive care unit (ICU) or critical care unit (CCU) days: mean difference 0.35 more days for physicians, P < .001); using hospice: OR = 1.23, 95% CI = 1.18-1.29; number of days in hospice: mean difference 2.06, P < .001).
  
  
  
  This retrospective, observational study is subject to unmeasured confounders and variation in coding practices, but it provides preliminary evidence of actual use. U.S. physicians were more likely to use hospice and ICU- or CCU-level care. Hospitalization rates were similar.
authors.affiliation: Division of Geriatrics, School of Medicine, University of Colorado, Aurora, Colorado.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Matlock
authors.affiliation: Undergraduate Medical Education, School of Medicine, University of Colorado, Aurora, Colorado.
authors.forename: Traci E
authors.initials: TE
authors.lastname: Yamashita
authors.affiliation: Division of Health Care Policy and Research, School of Medicine, University of Colorado, Aurora, Colorado.
authors.forename: Sung-Joon
authors.initials: SJ
authors.lastname: Min
authors.affiliation: Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California.
authors.forename: Alexander K
authors.initials: AK
authors.lastname: Smith
authors.affiliation: Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York.|Geriatric Research Education and Clinical Centers, James J Peters Veterans Affairs Medical Center, Bronx, New York.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Kelley
authors.affiliation: Division of General Internal Medicine, School of Medicine, University of Colorado, Aurora, Colorado.
authors.forename: Stacy
authors.initials: S
authors.lastname: M Fischer
mesh_terms: D000368:Aged; D005260:Female; D006738:Hospices / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D016344:Medicare Part A; D010820:Physicians; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013727:Terminal Care / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology
keywords: Medicare; end of life; hospice; physicians