End‐of‐life quality metrics among medicare decedents at minority‐serving cancer centers: A retrospective study

作者：Garrett T. Wasp, Shama S. Alam, Gabriel A. Brooks, Inas S. Khayal, Nirav S. Kapadia, Donald Carmichael, Andrea M. Austin, Amber E. Barnato · 发表于：Cancer Medicine · 年份：2020 · DOI：10.1002/cam4.2752 · 被引用次数：44 · 研究领域：Palliative Care and End-of-Life Issues、Frailty in Older Adults、Cancer survivorship and care

BACKGROUND: We calculated the performance of National Cancer Institute (NCI)/National Comprehensive Cancer Network (NCCN) cancer centers' end-of-life (EOL) quality metrics among minority and white decedents to explore center-attributable sources of EOL disparities. METHODS: We conducted a retrospective cohort study of Medicare beneficiaries with poor-prognosis cancers who died between April 1, 2016 and December 31, 2016 and had any inpatient services in the last 6 months of life. We attributed patients' EOL treatment to the center at which they received the preponderance of EOL inpatient services and calculated eight risk-adjusted metrics of EOL quality (hospice admission ≤3 days before death; chemotherapy last 14 days of life; ≥2 emergency department (ED) visits; intensive care unit (ICU) admission; or life-sustaining treatment last 30 days; hospice referral; palliative care; advance care planning last 6 months). We compared performance between patients across and within centers. RESULTS: Among 126,434 patients, 10,119 received treatment at one of 54 NCI/NCCN centers. In aggregate, performance was worse among minorities for ED visits (10.3% vs 7.4%, P < .01), ICU admissions (32.9% vs 30.4%, P = .03), no hospice referral (39.5% vs 37.0%, P = .03), and life-sustaining treatment (19.4% vs 16.2%, P < .01). Despite high within-center correlation for minority and white metrics (0.61-0.79; P < .01), five metrics demonstrated worse performance as the concentration of minorities incr...