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Quality of End-of-Life Care Among Rural Medicare Beneficiaries With Colorectal Cancer.
- Source :
- Journal of Rural Health; Sep2014, Vol. 30 Issue 4, p397-405, 9p
- Publication Year :
- 2014
-
Abstract
- Background Although previous research has documented rural disparities in hospice use, limited data exist on the roles of geographic access in different types of end-of-life indicators among cancer survivors. Methods Medicare claims data were used to identify beneficiaries with colorectal cancer who died in 2008 (N = 34,975). We evaluated rural-urban differences in ER visits 90 days before death, inpatient hospital admissions ≤90 days before death, intensive care unit (ICU) use ≤90 days before death, hospice care use at any time, and hospice enrollment <3 days before death. Results About 60% of beneficiaries in rural areas lived in counties with the 2 lowest socioecomonic levels compared to only 5.3% of beneficiaries in metropolitan areas. After adjusting for demographic factors and comorbidities, beneficiaries in rural counties had a lower number of ICU days (RR = 0.65) and were less likely to ever use hospice (OR = 0.78) compared to those in metropolitan counties. Beneficiaries from racial/ethnic minority groups, those with lower socioeconomic status, and those with a higher comorbidity index were less likely to ever use hospice but they tended to use ER, inpatient care, and ICU. Conclusions Evidence for disparities due to geographic access and socioeconomic factors warrant increased efforts to remove systemic and structural barriers. Future research should focus on exploring and evaluating potential policy and practice interventions to improve the quality of life among elderly cancer survivors living in rural communities and those from socioeconomically disadvantaged backgrounds. [ABSTRACT FROM AUTHOR]
- Subjects :
- ANALYSIS of variance
CANCER patient medical care
CHI-squared test
COLON tumors
HEALTH services accessibility
HEALTH status indicators
INTENSIVE care units
MEDICAL quality control
MEDICARE
PALLIATIVE treatment
RECTUM tumors
REGRESSION analysis
RESEARCH funding
SOCIOECONOMIC factors
RELATIVE medical risk
DATA analysis software
MEDICAL coding
DESCRIPTIVE statistics
ODDS ratio
Subjects
Details
- Language :
- English
- ISSN :
- 0890765X
- Volume :
- 30
- Issue :
- 4
- Database :
- Complementary Index
- Journal :
- Journal of Rural Health
- Publication Type :
- Academic Journal
- Accession number :
- 98643661
- Full Text :
- https://doi.org/10.1111/jrh.12074