摘要
【Abstract】【Background】Emergency department (ED) visits at end‐of‐life may cause financial strain and serve as a marker of inadequate access to community services and health care. We sought to examine end‐of‐life ED use, total healthcare spending, and out‐of‐pocket spending in a nationally representative sample.【Methods】Using Medicare Current Beneficiary Survey data, we conducted a pooled cross‐sectional analysis of Medicare beneficiaries aged 65+ years with a date of death between July 1, 2015 and December 31, 2021. Our primary outcomes were ED visits, total healthcare spending, and out‐of‐pocket spending in the 7, 30, 90, and 180 days preceding death. We estimated a series of zero‐inflated negative binomial models identifying patient characteristics associated with the primary outcomes.【Results】Among 3812 older adult decedents, 610 (16%), 1207 (31.7%), 1582 (41.5%), and 1787 (46.9%) Medicare beneficiaries had ED visits in the final 7, 30, 90, and 180 days, respectively, of life. For Medicare beneficiaries with at least one ED visit in the final 30 days of life, the median total and out‐of‐pocket costs were, respectively, $12,500 and $308, compared, respectively, with $278 and $94 for those without any ED visits (p < 0.001 for both comparisons). Having a diagnosis of dementia (odds ratio [OR] 0.71; 95% confidence interval [CI] 0.51–0.99; p = 0.04) and being on hospice status during the year of death (OR 0.56; 95% CI 0.48–0.66; p = <0.001) were associated with a decreased likelihood of having an ED visit. Having dementia was associated with a decreased likelihood of having any healthcare spending (OR 0.50; 95% CI 0.36–0.71; p = 0.001) and any out‐of‐pocket spending (OR 0.51; 95% CI 0.36–0.72; p = <0.001).【Conclusions】One in three older adults visit the ED in the last month of life, and approximately one in two utilize ED services in the last half‐year of life, with evidence of associated considerable total and out‐of‐pocket spending.
摘要译文
【摘要】【背景】急诊室（ED）在最终生命时访问可能会引起财务压力，并成为获得社区服务和医疗保健不足的标志。我们试图检查全国代表性的样本中的最终使用，医疗保健支出以及货运支出。【方法】使用Medicare当前的受益人调查数据，我们对65岁以上的Medicare受益人进行了合并的横断面分析，年龄在2015年7月1日，2015年7月1日，超过2015年12月1日和12月31日的保健日期，是2021年，我们的预期均为2021年，我们的访问量为2021年。死亡前的7、30、90和180天的货运支出。我们估计了一系列零燃料的负二项式模型，以识别与主要结果相关的患者特征。对于在生命的最后30天内至少进行一次ED访问的医疗保险受益人，中位数和货的中位成本分别为$ 12,500和308美元，分别为$ 12,500和308美元，没有任何ED访问的人为278美元和94美元（两次比较p <0.001）。诊断为痴呆症（优势比[OR] 0.71; 95％置信区间[CI] 0.51-0.99; P = 0.04），并且在死亡年内保持临终关怀（OR 0.56; 95％CI 0.48–0.66; P = <0.001）与Ed eD访问的类似访问的降低相关。患有痴呆症与任何医疗保健支出的可能性降低有关（OR 0.50; 95％CI 0.36–0.71; P = 0.001）和任何货的支出（OR 0.51; 95％CI 0.36-0.72; p = <0.001; 95％ci 0.36-0.72; p = <0.001）。在生命的最后半年中的服务，有相关的总体和货舱支出的证据。
Cameron J. Gettel [1];Courtney Kitchen [2];Craig Rothenberg [3];Yuxiao Song (0009-0001-6275-2780) [4];Susan N. Hastings [5];Maura Kennedy [6];Kei Ouchi [7];Adrian D. Haimovich (0000-0002-4106-7055) [8];Ula Hwang (0000-0002-3715-3073) [9];Arjun K. Venkatesh [10];. End‐of‐life emergency department use and healthcare expenditures among older adults: A nationally representative study[J]. Journal of the American Geriatrics Society, 2025,73(1): 101-111