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Influence of Peer Physicians on Intensity of End-of-Life Care for Cancer Decedents

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Background:

The intensity of end-of-life care varies substantially both within and between areas. Differing practice patterns of individual physicians are likely influenced by their peers.

Objective:

To assess whether intensity of end-of-life care previously provided by a physician’s peers influences patterns of care at the end-of-life for that physician’s patients.

Research Design:

Observational study.

Subjects:

A total of 185,947 fee-for-service Medicare enrollees with cancer who died during 2006–2010 who were treated by 26,383 physicians.

Measures:

Spending in the last month of life, >1 emergency room visit, >1 hospitalization, intensive care unit admission in the last month of life, chemotherapy within 2 weeks of death, no/late hospice, terminal hospitalization.

Results:

Mean (SD) spending in the last month of life was $16,237 ($17,124). For each additional $1000 of spending for a peer physician’s patients in the prior year, spending for the ego physician’s patients was $83 higher (P<0.001). Among physicians with peers both in and out of their practice, more of the peer effect was explained by physicians outside of the practice ($72 increase for each $1000 increase by peer physicians’ patients, P<0.001) than peer physicians in the practice ($27 for each $1000 increase by within-practice peer physicians’ patients, P=0.01). Results were similar across the other measures of end-of-life care intensity.

Conclusions:

Physician’s peers exert influence on the intensity of care delivered to that physician’s patients at the end-of-life. Physician education efforts led by influential providers and provider organizations may have potential to improve the delivery of high-value end-of-life care.
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Keywords: Medicare; end-of-life care; physician networks

Document Type: Research Article

Affiliations: 1: Department of Health Care Policy, Harvard Medical School, Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA 2: The Department of Biomedical Data Science and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH 3: Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 4: Department of Medical Oncology, City of Hope Cancer Center, Duarte, CA 5: Department of Health Care Policy, Harvard Medical School, Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA

Publication date: June 1, 2019

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