End-of-Life Care for Medicare Patients with Severe Chronic Illness (2001-2019)

<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 care for fee-for-service (FFS) Medicare beneficiaries, age 67 to 99 at death, who were diagnosed with one or more of 12 different severe chronic illnesses in the last two years of life. Examples of measures (calculated over the last six months and last two years of life) include total Medicare spending, days in hospital, days in intensive care, number of physician visits, number of medical specialist visits, percentage of deaths occurring in hospital, and percentage of beneficiaries enrolled in hospice care. Rates are provided at the state, hospital referral region (HRR), and hospital levels, and all rates have been adjusted for age, sex, race, primary chronic condition, and the presence of more than one chronic condition. </p>

<p>This entry also contains Dartmouth Atlas rates for a variety of measures related to end-of-life care for fee-for-service (FFS) Medicare beneficiaries, age 66 to 99 at death, who were diagnosed with a poor prognosis cancer in the last six months of life. Examples of measures include number of physician visits during the last six months of life, days in intensive care during the last month of life, percentage of patients receiving chemotherapy during the last two weeks of life, percentage of deaths occurring in hospital, and percentage of patients enrolled in hospice care. Rates are provided at the state, hospital referral region (HRR), and hospital levels, and all rates have been adjusted for age, sex, race, cancer type, and chronic illness. </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><p>

<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>