Intensity of acute care services at the end of life: nonclinical determinants of treatment variation in an older adult population.

Abstract

Technological advances in medicine have led to increasing complexity in health care decision making, and subsequently, greater opportunity for variation in the delivery of end-of-life care. Factors such as age, race/ethnicity, physician and hospital system characteristics, and geographic location have been found to be strong predictors of variation in acute interventions before death, even when controlling for medical acuity. The study presented here explores factors affecting health care utilization at end of life for a hospitalized older adult population in a major metropolitan area of Arizona. The study results reveal that effects of age, minority status, health plan, and hospital characteristics all affect hospital utilization and intensity of care above and beyond clinical factors.