Table 1: Characteristics of Included Studies Author Study Year Cohort Design Measure Cher and Lenert, 1997 1994 81,494 Medicare patients hospitalized in ICUs in California Retrospective cohort design Adjusted potentially ineffective care: death or death within 100 days of hospital discharge and total hospital costs above the 90th percentile Pritchard et al., 1998 1992-1993 Patients dying in the five-hospital, observational SUPPORT study and Medicare beneficiaries who died in 1992 or 1993 Ecologic study Percent dying at home or in the hospital Fisher et al., 2003 Mid-1994 to 1997 CMS claims data for expenditures. Then one-year and five-year sample data on content, accessibility, and quality of care. In 306 hospital referral regions (HRRs), Medicare Parts A and B fee-for-service patients hospitalized for hip fracture, colorectal cancer, or acute myocardial infarction (1993-1995) and a representative sample from the 1992-1995 Medicare Beneficiary Survey Prospective cohort Ecologic study for correlation of aggregate measures Content, accessibility of care, and quality of care (e.g., preventive services and acute myocardial infarction process measures) with different levels of EOL expenditures Wennberg et al., 2004 1999-2000 115,089 Medicare decedents from 77 hospitals on the 2001 US News and World Report list of best hospitals Retrospective case series of those who died The last six months of life: number of days spent in hospital and in intensive care units; number of physician visits; percentage of patients seeing 10 or more physicians; and percentage enrolled in hospice Teno et al., 2005 1998 Mortality date; survey date unknown Decedents in high- (n=365) and (n=413) hospital service areas Survey of family members of decedents Survey-derived information about unmet needs, concerns, and rating of quality EOL care in five domains hospitalization low-
Table 1 Continued Author Study Year Cohort Design Measure Barnato et al., 2007a March to October 2005 Survey and 2000-2003 CMS Dartmouth Atlas 2,515 survey responders survey Ecological study EOL Expenditure Index (Medicare spending in last six months of life) Barnato et al., 2007b 1989-1999 Medicare decedents (n=976,220) and survivors (n=845,306) aged 65 or more years old with at least one hospital admission Retrospective case series of survivors and decedents Receipt of ICU admission and intensive procedure over 12 months Barnato et al., 2007c 2004 Survey 2000 and 2004 EOL Intensity Rates 139 administrative and clinical staff from 11 Pennsylvania hospitals Survey of staff Ecologic study for correlation of measures Survey-derived perceptions of hospital's norms of EOL decision making and treatment Lin et al., 2009 April 2005 PHC4 and June 2005-May 2006 survey 124 hospitals in Pennsylvania completed the survey Survey of chief nursing officers Retrospective cohort of patients with high probability of dying Ecologic study for correlation of measures Hospital-level ratios of ICU admission, ICU length of stay, and life-sustaining treatment use among admissions with a high probability of dying Survey information about hospital and ICU programs, policies, or practices Smith et al., 2009 1992 to 1999 40,960 Medicare decedents with advanced cancer Retrospective case series of those who died with advanced cancer Percent enrolled in hospice, hospitalized two or more times in the last month of life, spent more than 14 days hospitalized in the last month of life, admitted to the intensive care unit in the last month of life, or died in the hospital Table 1 Continued Author Study Year Cohort Design Measure Teno et 2000-2007 2,797 hospitals with at Ecologic study Rate of feeding tube
and four patients and families at a low intensity academic medical center (AMC) and high intensity AMC, respectively. each AMC and withdrawal of treatment Barnett et al., 2012 2006 CMS encounter data, 2006 American Medical Association (AMA) and American Hospital Association (AHA) descriptive data, and 2001-2005 Dartmouth Atlas cost and intensity data 2.6 million Medicare Part A and B patients hospitalized for one of nine life-threatening conditions in the last two years of life (61,146 physicians associated with 528 hospitals) Retrospective case series of Medicare patients hospitalized at least once in last two years of life Ecologic study for correlation of aggregate measures Hospital-level spending (three measures) and intensity (six measures) in the last two years of life Miesfeldt et al., 2012 2003 to 2007 235,821 Medicare cancer decedents Retrospective case series of those who died with cancer Proportion with more than one or ER visit in the last 30 days of life, an admission to ICU in the last 30 days, a death in an acute care hospital, chemotherapy in the last 14 and 30 days of life, no admission to hospice within the last 6 months of life, and admission to hospice within 3 days of death Table 1 Continued Author Study Year Cohort Design Measure Baker et al., 2014 2005 survey, 2005 mortality and spending data, and 2016 4,000 Medicare decedents survey Medicare spending and preferences around physicians, health status, and health care in the last