Patterns and Predictors of Home Health and Hospice Use by Older Adults with Cancer

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Abstract

OBJECTIVES

To describe patterns of home health and hospice use by older cancer patients and a comparison group of older persons without cancer. To identify predictors of home care and hospice utilization.

DESIGN

Retrospective analysis using the Surveillance, Epidemiology and End Results (SEER)-Medicare Database, a linkage of the SEER Program of the National Cancer Institute (an epidemiological surveillance system of population-based tumor registries) and Medicare Claims.

SETTING

The SEER data used in this paper cover a service area that includes approximately 14% of the U.S. population, including the states of Connecticut, Hawaii, Iowa, and New Mexico and the metropolitan areas of Detroit, San Francisco–Oakland, Atlanta, Seattle–Puget Sound, Los Angeles County, and San Jose–Monterey.

PARTICIPANTS

Five analytical samples were drawn. The first consisted of all cases with a diagnosis of cancer in 1997 to 1999 who were eligible for services in calendar year 1999 (n = 120,072). The second and third were subsamples of these and consisted of cases with a new cancer diagnosis in 1999 (n = 46,373) and cases who died in 1999 (n = 41,483). The fourth consisted of a comparison sample without cancer (n = 160,707). The fifth was a subsample of this and consisted of those who died in 1999 (n = 6,639).

MEASUREMENTS

Utilization rates of home health and hospice services.

RESULTS

Twenty-nine percent of cancer patients used home health services, and 10.7% used hospice services, compared with 7.8% of noncancer patients who used home health and less than 1% who used hospice. Half (51.4%) of cancer patients who used home health did not have cancer listed as an admitting diagnosis for the use of those services. Home health utilization was lowest for unmarried men.

CONCLUSION

This is the first study to evaluate community-based home health and hospice utilization by older cancer patients. Future studies must begin to address what constitutes appropriate utilization.

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