The lack of effect of market structure on hospice use.

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dc.contributor.author Iwashyna, Theodore J.
dc.contributor.author Chang, Virginia W.
dc.contributor.author Zhang, James X.
dc.contributor.author Christakis, Nicholas A.
dc.date.accessioned 2008-12-18T21:35:13Z
dc.date.available 2008-12-18T21:35:13Z
dc.date.issued 2002-12
dc.identifier.citation Health Serv Res. 2002 Dec;37(6):1531-51. <http://hdl.handle.net/2027.42/61410> en
dc.identifier.uri http://hdl.handle.net/2027.42/61410
dc.description.abstract OBJECTIVE: To describe the relative importance of health care market structure and county-level demographics in determining rates of hospice use. DATA SOURCES: Medicare claims data for a cohort of elderly patients newly diagnosed with lung cancer, colon cancer, stroke, or heart attack in 1993, followed for up to five years, and linked to Census and Area Resource File data. STUDY DESIGN: Variation between markets in rates of hospice use by patients with serious illness was examined after taking into account differences in individual-level data using hierarchical linear models. The relative explanatory power of market-level structure and local demographic variables was compared. DATA COLLECTION METHODS: The cohort was defined within the Medicare hospital claims data using validated algorithms to detect incident cases of disease with a three-year lookback. Use of hospice was determined by linkage at an individual level to the Standard Analytic Files for Hospice through 1997. Individual-level data was linked to the Area Resource File using county identifiers present in the Medicare claims. PRINCIPAL FINDINGS: There is substantial variation in hospice use across markets. This variation is not explained by differences in the major components of health care infrastructure: the availability of hospital, nursing home, or skilled nursing facilities, nor by the availability of HMOs, doctors, or generalists. CONCLUSIONS: Intercounty heterogeneity in hospice use is substantial, and may not be related to the set-up of the medical care system. The important local factors may be local preferences, differences in the particular mix of services provided by local hospices, or differences in community leadership on end of life-issues; many of these differences may be amenable to educational efforts. en
dc.format.extent 521439 bytes
dc.format.mimetype application/pdf
dc.language.iso en_US en
dc.publisher Health Services Research en
dc.subject Hospice en
dc.subject End of Life Care en
dc.subject Medicare en
dc.subject Small Area Variations en
dc.subject HLM en
dc.subject Hierarchical Models en
dc.title The lack of effect of market structure on hospice use. en
dc.type Article en
dc.subject.hlbsecondlevel Internal Medicine and Specialities
dc.subject.hlbtoplevel Health Sciences
dc.contributor.affiliationum Pulmonary and Critical Care Medicine, Division of en
dc.contributor.affiliationum Internal Medicine, Department of en
dc.contributor.affiliationumcampus Ann Arbor en
dc.identifier.pmid 12546285
dc.description.bitstreamurl http://deepblue.lib.umich.edu/bitstream/2027.42/61410/1/02.I.Chang.Zhang.C.HSR.pdf
dc.owningcollname Pulmonary & Critical Care Medicine, Division of
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