Elevated end-of-life spending: A new measure of potentially wasteful health care spending at the end of life

In an article published by Health Services Research, Dr. Yongkang Zhang, assistant professor of population health sciences, Dr. Jing Li, assistant professor of population health sciences, and colleagues constructed and examined elevated end-of-life (EoL) spending, a new measure of EoL spending. 

Researchers constructed the elevated EoL spending measure as the differential monthly spending between decedents and survivors with the same one-year mortality risk. Researchers examined the associations of hospital referral region (HRR)-level elevated EoL spending with various health care quality measures, as well as survey-elicited patient and provider preferences. They further examined analogous associations for monthly total EoL spending on decedents. 

Results show large variation in elevated EoL spending across HHRs in the United States, and positive association between total EoL spending and certain quality of care measures. Elevated EoL spending was positively associated with physician preferences for treatment intensity, but not with patient preferences for EoL care. 

Findings suggest that elevated EoL spending captures different resource use than conventional measures of EoL spending, and may be valuable in identifying wasteful spending. 

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