Presentation Authors: Lindsey Herrel*, Ziwei Zhu, Deborah Kaye, Chad Ellimoottil, James Dupree, Brent Hollenbeck, David Miller, Ann Arbor, MI
Introduction: Dual eligible beneficiaries, those that qualify for Medicare based on age and Medicaid due to low income, are a particularly vulnerable population with much to gain from efforts to improve quality. Integrated delivery systems (IDS), with their emphasis on care coordination and communication, may help improve quality of care for dual eligible patients at the end of life. Our objective is to define the quality of care for dual eligible patients with urological malignancies at the end of life across various delivery systems.
Methods: We used Surveillance, Epidemiology and End Results registry data linked with Medicare claims to evaluate quality for beneficiaries who died from bladder, kidney or prostate cancer and were diagnosed from 2008 through 2013. We evaluated adherence to seven nationally endorsed end of life quality measures according to patient&[prime]s dual eligible status and receipt of care in an IDS using generalized linear models. We compared end of life quality measure performance for dual eligible and non-dual eligible beneficiaries, and for dual eligible patients in IDS and non-IDS.
Results: Among 11,703 beneficiaries who died from prostate, kidney or bladder cancer during the study interval, we identified inferior outcomes for dual eligible beneficiaries across nearly every quality measure assessed (Figure). Compared to non-dual eligible beneficiaries, dual eligible patients were more likely to have >1 hospitalization (12.3% vs 10.6%), were more likely to die in a hospital setting (25.8% vs 23.3%) and have multiple ED visits (15.8% vs 12.5%), all p < 0.05). We noted no differences in quality measure performance for dual eligible patients treated in IDS versus non-IDS.
Conclusions: Dual eligible status is associated with inferior quality measure performance at the end of life for patients with genitourinary malignancies. These disparities were not dampened by receipt of care in an IDS. These findings suggest targeted efforts may be needed to optimize quality at the end of life for this group of vulnerable patients who face unique socioeconomic challenges.
Source of Funding: National Cancer Institute (1-R01-CA-174768-01-A1 to DCM)