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P OSTER
A BSTRACTS
life care. Application of this benefit to NH residents has come under
increasing scrutiny due to dramatic expansion in recent years and increasing
costs. We used a unique merged dataset to describe trends
over time in NH patients who used hospice.
Methods:Between 1999-2009, data was collected on 33,387 people
over age 65 who had contact with a large, urban public hospital
which serves a population that is largely poor, about 60% women and
35% black. Clinical data from the local comprehensive electronic
medical record was merged with Medicare claims, Indiana Medicaid
claims, Minimum Data Set, and Outcome and Assessment Information
Set. Patients with a hospice claim and the sub-group of hospice
patients in NHs were identified. We present trends over time with descriptive
statistics.
Results: 4361 patients used hospice in the 10 year period; about
1/3 of overall decedents enrolled in hospice. About 1/3 of the overall
cohort had a nursing home stay. There were 1260 patients who used
hospice and lived in NHs. In this NH-hospice cohort 62% of patients
were female; 61% were white and 38% were black. Average age at
hospice enrollment was 81 years and did not change appreciably over
time. A trend of increased enrollment over time was evident. The proportion
of NH-hospice patients with non-cancer diagnoses increased
over time from 35% in 1999 to 79% in 2009. In 1999, the median
length of stay on hospice was 93 days (mean 195 days) and remained
high throughout the study period. The overall median for the 10 year
period was 85 days (mean 161). For hospice patients not in NHs, the
median length of stay was 16 days (mean 58).
Conclusions: Consistent with national data, the use of hospice
by nursing home patients and proportion with non-cancer diagnoses
has risen over time. A striking difference from other studies is the
much longer length of stay of NH-hospice patients throughout the 10
year study period. In contrast to our results, NH-hospice patients
were found to have a median length of stay of 46 days in 1999 and a
steady increase over time in a national sample. Additional analyses
will use this rich dataset to probe factors affecting length of stay and
use of hospice in this population of vulnerable older adults.
B111
Can primary care providers estimate remaining life expectancy in
older adults with chronic kidney disease and other comorbidities?
K. H. Campbell, 1 S. G. Smith, 2 C. Fox, 3 J. W. Mold, 4 J. W. Shega, 1
W. Dale. 1 1. Section of Geriatrics and Palliative Medicine, University
of Chicago, Chicago, IL; 2. Pritzker School of Medicine, University of
Chicago, Chicago, IL; 3. UNYNET, University at Buffalo, Buffalo,
NY; 4. OKPRN, University of Oklahoma, Oklahoma City, OK.
Supported By: Supported by the John A. Hartford Foundation
Center of Excellence in Geriatrics at the University of Chicago Pilot
Research Award.
Background: Estimating remaining life expectancy (RLE) is
considered preferable to using age to guide medical decision-making
for older adults. We evaluated whether primary care providers
(PCPs) were able to estimate RLE in older patients with chronic kidney
disease (CKD) and various comorbidities with known RLE associations.
Methods: Using a cross-sectional survey of PCPs in 2 practicebased
regional networks designed to evaluate referral decisions for
older adults with chronic kidney disease, we developed clinical vignettes
of older adults. Vignettes randomly varied 6 factors dichotomously
(age, race, gender, presence of stage III congestive heart failure
(CHF), ability to ambulate, and presence of moderate dementia)
in a block factorial design. PCPs were asked to estimate RLE of vignette
patients. We categorized vignettes as: 1) no comorbidities; 2)
presence of CHF; 3) presence of dementia; and 4) presence of both
CHF and dementia. Each category was assigned an “expected” RLE
using life tables, placing each group into upper, middle, and lower
quartiles by age and gender. We compared the mean RLE estimated
by the PCPs with the expected RLE from life tables using t-test.
Results: Eighty-two PCPs answered RLE questions about 8 randomly-assigned
vignettes. Providers significantly underestimated
RLE of patients assigned to the “no comorbidities”: women age 67
RLE estimate 12.4 years versus life table expected RLE 21.3 years;
p