End of Life Inpatient Care (1994-2019)

<h2>Overview</h2>
<p>The Dartmouth Institute for Health Policy and Clinical Practice (TDI) has created a publicly available source of data that provides researchers, payers, regulators, and innovators with metrics that quantify temporal and regional patterns of health care spending and utilization in the United States. Using CMS Medicare claims data (mostly for age >64 enrollees), Atlas researchers built cohorts (“denominators”) and numerous measures or events (“numerators”) which were then used to calculate rates either by geography or for patients assigned to specific hospitals. These rates, which are calculated consistently across time and place, provide researchers with opportunities to evaluate spatial and temporal variation/trends. </p>

<p>This entry contains Dartmouth Atlas rates for a variety of measures related to end-of-life inpatient care for Medicare beneficiaries age 65 to 99 at death. Decedents were required to have Medicare fee-for-service (FFS) coverage throughout the six months prior to death. Examples of measures (calculated over the last six months of life) include total inpatient spending, days in hospital, days in intensive care, and percentage of deaths occurring in hospital. Rates are provided at the state, county, hospital referral region (HRR), and hospital service area (HSA) levels, and all rates have been adjusted for age, sex, and race. For the 2008-2019 period, the rates provided for each geographic area include overall annual rates, rates stratified by race (black and non-black), and rates stratified by gender (male and female). For the 1994-2007 period, only the overall annual rates are provided.</p>

<p> Users downloading data should review the methods sections of the related publications for context as well as for information about any temporal changes in methods. All reports in the Dartmouth Atlas of Health Care series are available from the National Library of Medicine <a href="https://www.ncbi.nlm.nih.gov/books/NBK584737/">https://www.ncbi.nlm.nih.gov/books/NBK584737/</a>
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<p> Note that for the general Dartmouth Atlas rate datasets, which span multiple decades, the author list includes all Dartmouth staff (programmers, analysts, supervisors, etc.) involved in generating all types of Atlas rates across all years. We do not attempt to assign individuals to specific datasets or years. <p>