Health Services Research

SS 44 - HSR 2 - Health Services Research

325 - Healthy Days at Home: A Population-Based Quality Measure for Cancer Patients at the End of Life?

Wednesday, October 24
3:45 PM - 3:55 PM
Location: Room 008

Healthy Days at Home: A Population-Based Quality Measure for Cancer Patients at the End of Life?
M. Lam1,2, L. G. Burke2, K. Reimold2, E. J. Orav3, and A. Jha2; 1Brigham and Women's Hospital / Dana Farber Cancer Institute, Boston, MA, 2Harvard T.H. Chan School of Public Health, Boston, MA, 3Brigham and Women's Hospital, Boston, MA

Purpose/Objective(s): Patient surveys find that most Americans would prefer to spend as much time at home as possible when they have a terminal illness, yet more than a quarter of Medicare beneficiaries are still dying in healthcare institutions. One way to assess how well the healthcare system is keeping people out of institutions and at home is to calculate Healthy Days At Home (HDAH), a novel population-based measure. We used this measure to answer three questions about patients with a cancer diagnosis: first, what proportion of their last 6 months was spent at home? Second, how much does HDAH vary by the characteristics of the patient? And finally, how much does HDAH vary by the type of cancer?

Materials/Methods: We identified Medicare beneficiaries aged 66 or older with a cancer diagnosis who died in 2014 or 2015. Using ICD-9 codes, we categorized malignancies into the following types: lung, hematologic, gastrointestinal, breast, genitourinary, head and neck, sarcoma, melanoma, central nervous system, and metastatic disease of unknown primary. For each beneficiary, we calculated HDAH for the 180 days prior to death and subtracted the following measure components from 180 days: the total number of days spent in inpatient, observation, skilled nursing facility (SNF), inpatient psychiatry, inpatient rehabilitation, and long-term hospital settings, as well as number of outpatient emergency department (ED), and home health visits (HHA). HDAH were adjusted for age, sex and comorbidities.

Results: The mean HDAH in the last 180 days of life for all patients with cancer was 130.5 days. The components with the largest impact on HDAH were home health (18.3 visits), followed by inpatient (10.8 days), SNF (10.3 days), and ED (1.8 days) utilization for all cancer patients. When examining HDAH by patient demographic characteristics, we found that female cancer patients had fewer HDAH than men (100.7 vs 111.3). Additionally, we found differences in HDAH with Hispanic patients with cancer having the fewest HDAH (mean 97.2 days), followed by black patients (98.2 days), whereas white beneficiaries had the highest number of HDAH (106.9 days). There were differences in the underlying components of HDAH by race with Hispanic beneficiaries having more home health visits on average (11.0 visits) compared to black (7.7 days) and white (6.9) beneficiaries. Black beneficiaries, by contrast, had the greater number of SNF days (11.7) compared to white (10.3) and Hispanic (7.1). When broken down by cancer type, patients dying with breast cancer had the highest number of HDAH (135.0), while patient dying with CNS cancers had the lowest number of HDAH (122.7).

Conclusion: HDAH is a population-based measure that may be useful for capturing variation in end of life healthcare utilization and quality for patients dying with cancer and understanding how patterns vary by key beneficiary characteristics.

Author Disclosure: M. Lam: None. L.G. Burke: None. E.J. Orav: None.

Miranda Lam, MD, MBA

Brigham & Women's Hospital

Disclosure:
No relationships to disclose.

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