Presentation Authors: Deborah Kaye*, Ziwei Zhu, Chad Ellimoottil, James Dupree, David Miller, Lindsey Herrel, Ann Arbor, MI
Introduction: Health systems have the potential to optimize value by lowering costs and improving quality of care at the end of life for Medicare beneficiaries with cancer. Health systems that are certified cancer centers or integrated delivery systems have a unique focus on care coordination, communication and quality which may help improve quality at the end of life for cancer patients. Little is currently known about the association between cancer center status or integrated delivery system status and quality outcomes for patients with urological malignancies at the end of life.
Methods: We used Surveillance, Epidemiology and End Results registry data linked with Medicare claims to evaluate quality for patients who died from bladder, kidney or prostate cancer and were diagnosed from 2008 through 2013. Patients were categorized as receiving the majority of their care in an integrated delivery system, certified cancer center, health system that was both or neither. We evaluated adherence to seven nationally endorsed end of life quality measures using generalized linear models and compared quality across health system characteristics.
Results: Among 11,703 beneficiaries who died from prostate, kidney or bladder cancer during the study interval, we identified minimal differences in quality measure performance for patients treated in health systems regardless of integration and/or cancer focus (Figure). Patients who were treated in a health system with either a cancer center or integrated health system affiliation were less likely to have an in hospital death compared to non-affiliated health systems (CC 23.6%, IDS 22.8%, Both 22.2%, Neither 26.1%, p=0.02).
Conclusions: Quality of care at the end of life for patients with urologic cancers was similar across delivery systems, including at integrated and cancer focused systems. These findings highlight the need to understand factors beyond health system characteristics that influence complex decision making at the end of life.
Source of Funding: National Cancer Institute (1-R01-CA-174768-01-A1 to DCM)