OBJECTIVES: To examine contemporary trends in @entity5 care and geographic variation of end-of-life care @entity146 among Medicare beneficiaries. MATERIALS AND METHODS: Using the Surveillance, Epidemiology, and End Results-Medicare data, we identified 132,051 beneficiaries who died as a result of @entity5 in 2006-2011. @entity146 of end-of-life care was measured by chemotherapy received within 14days of @entity204 , >1 @entity341 ( @entity341 ) visit within 30days of @entity204 , >1 hospitalization within 30days of @entity204 , >= 1 intensive care unit (ICU) admission within 30days of @entity204 , in-hospital @entity204 , or hospice enrollment  <=3days before @entity204 . Using hierarchical generalized linear models, we assessed potentially aggressive end-of-life care adjusting for @entity1 demographics, @entity5 characteristics, and hospital referral region (HRR)-level market factors. RESULTS: The proportion of beneficiaries receiving at least one potentially aggressive end-of-life intervention increased from 48.6% in 2006 to 50.5% in 2011 (P<.001). From 2006 to 2011, increases were apparent in repeated hospitalization (14.1% vs. 14.8%; P=.01), repeated @entity341 visits (34.3% vs. 36.6%; P<.001), ICU admissions (16.2% vs. 21.3%; P<.001), and late hospice enrollment (11.2% vs. 12.9%; P<.001), whereas in-hospital @entity204 declined (23.5% vs. 20.9%; P<.001). End-of-life chemotherapy use (4.4% vs. 4.5%) did not change significantly over time (P=.12). The use of potentially aggressive end-of-life care varied substantially across HRRs, ranging from 40.3% to 58.3%. Few HRRs had a decrease in aggressive end-of-life care during the study period. CONCLUSIONS: Despite growing focus on providing appropriate end-of-life care, there has not been an improvement in @entity5 care in the Medicare program.

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@entity1 :: ('9606', 'Species') :: ['patient'] @entity146 :: ('MESH:D001523', 'Disease') :: ['Aggressiveness', 'aggressiveness'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tumor', 'aggressive end-of-life cancer', 'cancer', 'end-of-life cancer'] @entity341 :: ('MESH:D004630', 'Disease') :: ['emergency department', 'ED'] @entity204 :: ('MESH:D003643', 'Disease') :: ['death']
@entity5 :: (MESH:D009369,Disease) :: ['Trends in end-of-life cancer']
