Outpatient palliative care and end-of-life care intensity: linking Massachusetts Cancer Registry with All-Payer Claims Database

Abstract

Background: Early palliative care is associated with better outcomes for patients with advanced-stage cancers. Using a novel data linkage, we assessed outpatient palliative care use before death and its association with end-of-life care intensity and variation across 8 provider networks in Massachusetts.

Methods: We linked Massachusetts Cancer Registry and the All-Payer Claims Database for individuals with commercial insurance, Medicaid, or Medicare Advantage diagnosed with colorectal, lung, prostate, and breast cancers from 2010 to 2013 who died by December 31, 2014. We characterized outpatient palliative care visits in the 6 months before death and identified end-of-life hospitalizations, emergency department visits, intensive care unit admissions, chemotherapy, no/late hospice enrollment, and in-hospital deaths. We used logistic regression to assess factors associated with outpatient palliative care and ordinal logistic regression with provider network fixed effects to assess the association of palliative care with a composite measure summing individual end-of-life intensity measures.

Results: Among 6279 decedents, 11.3% had at least 1 outpatient palliative care visit. Palliative care use varied across provider networks from 6.0% to 19.3%. In adjusted analyses, younger age, longer duration from diagnosis to death, death in 2012-2014 vs 2010, and provider network were associated with palliative care visits (all P values less than .05). End-of-life care intensity varied across provider networks. Patients with palliative care visits had lower adjusted odds of receiving intensive end-of-life care (adjusted odds ratio = 0.62 per additional measure of end-of-life intensity, 95% CI = 0.53 to 0.72).

Conclusions: Outpatient palliative care use varied substantially among regional provider networks and was associated with less intensive end-of-life care.