End-of-life quality metrics among medicare decedents at minority-serving cancer centers: A retrospective study.,Cancer Medicine

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End-of-life quality metrics among medicare decedents at minority-serving cancer centers: A retrospective study.
Cancer Medicine ( IF 2.9 ) Pub Date : 2020-01-11 , DOI: 10.1002/cam4.2752
Garrett T Wasp _{1,

2} , Shama S Alam ₃ , Gabriel A Brooks _{1,

2,

3} , Inas S Khayal _{3,

4} , Nirav S Kapadia _{1,

2,

3} , Donald Q Carmichael ₃ , Andrea M Austin ₃ , Amber E Barnato _{1,

2,

3}

Affiliation

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 increased: ED visits (P = .03), ICU admission (P < .01), no hospice referral (P < .01), and life-sustaining treatments (P < .01). CONCLUSION EOL quality metrics vary across NCI/NCCN centers. Within center, care was similar for minority and white patients. Minority-serving centers had worse performance on many metrics.

中文翻译：

少数族裔癌症中心医疗保险中死者的临终质量指标：一项回顾性研究。

背景技术我们计算了美国国家癌症研究所（NCI）/国家综合癌症网络（NCCN）癌症中心在少数族裔和白人后裔中的生命终期（EOL）质量指标的性能，以探索中心归因于EOL差异的来源。方法我们对2016年4月1日至2016年12月31日之间死亡，生命最后6个月内接受过住院治疗的癌症预后差的医疗保险受益人进行了一项回顾性队列研究。我们将患者的EOL治疗归因于他们主要接受EOL住院服务的中心，并计算了8种EOL质量的风险调整指标（临终关怀≤3天;临终前14天化疗;≥2急诊科（急诊部就诊；重症监护病房（ICU）入院；或持续30天的维持生命的治疗；临终关怀转诊; 姑息治疗；提前6个月的护理计划）。我们比较了中心内和中心内患者之间的表现。结果在126,434名患者中，有10,119名在54个NCI / NCCN中心之一接受了治疗。总体而言，在急诊就诊的少数族裔中表现较差（10.3％对7.4％，P <.01），入住ICU（32.9％对30.4％，P = .03），未接受临终关怀转诊（39.5％对37.0％，P = 0.03）和维持生命的治疗（19.4％比16.2％，P <0.01）。尽管少数族裔和白人指标的中心内相关性很高（0.61-0.79; P <.01），但随着少数族裔的集中度增加，五个指标表现较差：急诊就诊（P = .03），重症监护病房入院（P <.01 ），没有转诊临终关怀（P <.01）和维持生命的治疗（P <.01）。结论ECI质量指标在NCI / NCCN中心之间有所不同。在中心内，少数民族和白人患者的护理情况相似。少数民族服务中心在许多指标上的表现都较差。

更新日期：2020-01-13

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