MedicalResearch.com Interview with:
Shi-Yi Wang MD, PhD.
Department of Chronic Disease Epidemiology
Yale School of Public Health
New Haven, CT
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Care at the end of life is often fragmented and poorly coordinated across different health providers. Multiple transitions in care settings can be burdensome to patients and their families as well as costly to society. Despite these concerns about care transitions in the end of life, we lack contemporary data on the number, timing, and overall pattern of healthcare transitions in the last 6 months of life.
This study adds to the extant literature by understanding transition trajectories, national variation of the transitions, and factors associated with transitions. We found that more than 80% of Medicare fee-for-service decedents had at least one health care transition and approximately one-third had ≥ 4 transitions in the last 6 months of life. We produced Sankey diagrams to visualize the sequences of healthcare transitions. The most frequent transition pattern involving at least four transitions: home-hospital-home (or skilled nursing facility)-hospital-healthcare setting other than hospital. There was substantial geographic variation in healthcare transitions in the United States. We found that several factors were associated with a significantly increased risk of having multiple transitions, including female gender, blacks, residence in lower income areas, presence of heart disease or kidney disease.
MedicalResearch.com: What should readers take away from your report?
Response: Nearly one-third of Medicare beneficiaries who died in 2011 experienced ≥4 transitions in health care within the last 6 months of life. Many of them transitioned across hospital, skilled nursing facility, and home but not hospice in their first three transitions. The measurement of transition across healthcare settings, potentially using data visualization efforts such those as reported here, could be used to monitor the quality of end-of-life care.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: We lacked information about patient and family preferences regarding the impact of multiple transitions. Therefore, additional study, in which patient and family preferences can be elucidated and compared with these healthcare transition patterns, would be helpful.
MedicalResearch.com: Is there anything else you would like to add?
Response: To our knowledge, this is the first study to use Sankey diagrams to depict the patterns of end-of-life transitions in care.
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