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Administrative Data and Hospice Care
Author Bios
Introduction
Health Insurance Data
Basis for Payment Data
Hospice Claims Data
The Medicare Model
Claims Data Uses
Currently selected section: Hospice & Palliative Care
Statistical Challenges
Correct Denominators
Starting the Clock
Costs of EOL Care
Conclusions


Chapter 18: Using Adminstrative Data to Study Hospice Care: Hospice vs. Palliative Care
         

Hospice is a defined set of services whereas palliative therapy is usually defined as care with the intent of symptom control (or palliation). Three broad options can be used to quantify palliative care using administrative data:

  1. Consider any care in the final months of life to be palliative. While this is clearly a retrospective approach to end-of-life care, there are situations where it is appropriate. A word of caution, however: there will always be patients, even those with terminal illnesses, who die unexpectedly. Some of these patients may be receiving care that is considered to be curative in the most basic sense. Defining treatment based on outcome may result in some very nonsensical findings (e.g. aggressive surgery as palliative treatment).

  2. Carefully consider each treatment and classify it as: palliative, curative, or "cannot be determined". This is probably the most accurate in terms of connection to the practice of medicine. As noted earlier, one cannot explicitly discern intent from claims. It may be possible to take a 'rational doc' approach. That is, a rational practitioner would only place a patient on drug A if they believed the patient had a condition that was treatable by drug A. From this, certain medications that have a particular indication (e.g. pain control) may easily be defined as palliative. Certain doses of chemotherapy or radiation may follow a pattern that is more consistent with a goal of palliation than cure. There will likely be a number of services that cannot be classified and will need to be grouped as indeterminate. The primary disadvantage to this approach is that it will need to be repeated condition by condition, service by service. Thus, this will not be a particularly efficient way to study palliative care.

  3. Only consider care provided in hospice programs to be palliative. This will likely result in an under-ascertainment of end-of-life care because much palliative and even hospice-like care is provided outside of hospice care. This includes care prior to hospice entry and actual end-of-life care for persons who, for a variety of reasons, never formally enter a hospice program. This approach would result in conclusions that may not match clinical intuition--e.g. only 50% of persons dying of cancer receive any palliative care (Virnig, 2002). A more accurate conclusion might be that 50% of persons dying of cancer receive care in a formal hospice program. Even defining hospice is not as straightforward as one might expect. For hospice to be reimbursed under Medicare, the care must be provided in a Medicare certified hospice program. Alternate measures of hospice availability (e.g. American Hospital Association annual survey) provide estimates of hospice availability that do not line up with hospice availability as estimated via presence of a Medicare certified hospice. Medicare recipients receiving care in a non-certified hospice program will have their care described in other ways to allow for billing (e.g. routine home care through a home health agency). This care may well fit our ad hoc definitions of hospice but not fit our rigid definition of formal hospice care. The bottom line is that this is the easiest definition to implement, but probably under-represents the actual receipt of services that can appropriately be defined as palliative.

Clearly, none of these options is ideal. The correct choice necessarily involves choosing among advantages and disadvantages and considering the likely inference to be drawn from the study.

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