(HealthDay News) – Fewer Medicare beneficiaries are dying in the setting of acute care hospitals, but health care transitions and intensive care unit (ICU) utilization are increasing in the last month of life, according to a study published in the Feb. 6 issue of the Journal of the American Medical Association.

Joan M. Teno, MD, from Brown University in Providence, RI, and colleagues retrospectively analyzed data from a random 20% sample of fee-for-service Medicare beneficiaries, aged ≥66 years, who died in 2000 (270,202 decedents), 2005 (291,819), or 2009 (286,282). Billing data was used to identify medical diagnosis of cancer, chronic obstructive pulmonary disease, or dementia in the last 180 days of life.

The researchers observed a significant decrease in deaths occurring in the setting of acute care hospitals, accompanied by increases in ICU use in the last 30 days, hospice use at the time of death, and health care transitions in the last days of life. Of those in hospice at the time of death, 28.4% used hospice for ≤3days in 2009, and of these late hospice referrals, 40.3% had just had a hospitalization with an ICU stay.

“Among Medicare beneficiaries who died in 2009 and 2005 compared with 2000, a lower proportion died in an acute care hospital, although both ICU use and the rate of health care transitions increased in the last month of life,” the authors write.

Several authors disclosed receiving financial compensation for speaking and consulting on end-of-life issues.

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