Care Transitions Common at End of Life for Medicare Recipients

More than 80 percent have at least one transition, with many experiencing four or more

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WEDNESDAY, April 12, 2017 (HealthDay News) -- More than one-third of Medicare beneficiaries who died in 2011 had at least four care transitions during their last six months of life, according to a study published online April 3 in the Journal of the American Geriatrics Society.

Shi-Yi Wang, M.D., Ph.D., from Yale University in New Haven, Conn., and colleagues evaluated transitions between health care settings (e.g., hospital, skilled nursing facility, inpatient hospice, home hospice, home without hospice) in the last six months of life among Medicare beneficiaries aged 66 and older who died between July and December 2011.

The researchers found that more than 80 percent of the 660,132 decedents had at least one transition within the last six months of life, with 218,731 individuals having four or more transitions. The most frequent transition pattern (19.3 percent of all decedents) involved four or more transitions (home to hospital, back to home or skilled nursing facility, to hospital again, and then to settings other than hospital). There was substantial geographic variation in the average number of transitions in the last six months of life, ranging from 1.8 in Alaska to 3.1 in New Jersey. For decedents approaching death, transitions became more intensive. Four or more transitions were more likely in women, blacks, individuals younger than 85 years, and individuals without dementia.

"Identifying interventions that can facilitate care transitions consistent with beneficiaries' preferences is warranted," the authors write.

One author disclosed financial ties to the medical device and pharmaceutical industries.

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