Physician Preferences for Aggressive Treatment at the End of Life and Area-Level Health Care Spending: The Johns Hopkins Precursors Study. Gallo, J. J., Andersen, M. S., Hwang, S., Meoni, L., & Jayadevappa, R. Gerontology & Geriatric Medicine, 3:2333721417722328, December, 2017.
doi  abstract   bibtex   
Objective: To determine whether physician preferences for end-of-life care were associated with variation in health care spending. Method: We studied 737 physicians who completed the life-sustaining treatment questionnaire in 1999 and were linked to end-of-life care data for the years 1999 to 2009 from Medicare-eligible beneficiaries from the Dartmouth Atlas of Health Care (in hospital-related regions [HRRs]). Using latent class analysis to group physician preferences for end-of-life treatment into most, intermediate, and least aggressive categories, we examined how physician preferences were associated with health care spending over a 7-year period. Results: When all HRRs in the nation were arrayed in quartiles by spending, the prevalence of study physicians who preferred aggressive end-of-life care was greater in the highest spending HRRs. The mean area-level intensive care unit charges per patient were estimated to be US\$1,595 higher in the last 6 months of life and US\$657 higher during the hospitalization in which death occurred for physicians who preferred the most aggressive treatment at the end of life, when compared with average spending. Conclusions: Physician preference for aggressive end-of-life care was correlated with area-level spending in the last 6 months of life. Policy measures intended to minimize geographic variation in health care spending should incorporate physician preferences and style.
@article{gallo_physician_2017,
	title = {Physician {Preferences} for {Aggressive} {Treatment} at the {End} of {Life} and {Area}-{Level} {Health} {Care} {Spending}: {The} {Johns} {Hopkins} {Precursors} {Study}},
	volume = {3},
	issn = {2333-7214},
	shorttitle = {Physician {Preferences} for {Aggressive} {Treatment} at the {End} of {Life} and {Area}-{Level} {Health} {Care} {Spending}},
	doi = {10.1177/2333721417722328},
	abstract = {Objective: To determine whether physician preferences for end-of-life care were associated with variation in health care spending. Method: We studied 737 physicians who completed the life-sustaining treatment questionnaire in 1999 and were linked to end-of-life care data for the years 1999 to 2009 from Medicare-eligible beneficiaries from the Dartmouth Atlas of Health Care (in hospital-related regions [HRRs]). Using latent class analysis to group physician preferences for end-of-life treatment into most, intermediate, and least aggressive categories, we examined how physician preferences were associated with health care spending over a 7-year period. Results: When all HRRs in the nation were arrayed in quartiles by spending, the prevalence of study physicians who preferred aggressive end-of-life care was greater in the highest spending HRRs. The mean area-level intensive care unit charges per patient were estimated to be US\$1,595 higher in the last 6 months of life and US\$657 higher during the hospitalization in which death occurred for physicians who preferred the most aggressive treatment at the end of life, when compared with average spending. Conclusions: Physician preference for aggressive end-of-life care was correlated with area-level spending in the last 6 months of life. Policy measures intended to minimize geographic variation in health care spending should incorporate physician preferences and style.},
	language = {eng},
	journal = {Gerontology \& Geriatric Medicine},
	author = {Gallo, Joseph J. and Andersen, Martin S. and Hwang, Seungyoung and Meoni, Lucy and Jayadevappa, Ravishankar},
	month = dec,
	year = {2017},
	pmid = {28808668},
	pmcid = {PMC5528938},
	keywords = {Medicare, end-of-life care, health care costs, regional variation},
	pages = {2333721417722328}
}

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