Novel Data Sharing Between a Comprehensive Cancer Center and a Private Payer to Better Understand Care at the End of Life.

ABSTRACT

CONTEXT Understanding end-of-life (EOL) care patterns is a prerequisite to improving the experience for cancer patients. EOL measures endorsed by the National Quality Forum (NQF) have been examined in older patients using Medicare claims. OBJECTIVES: To evaluate EOL care for patients treated at a comprehensive cancer center, using private payer claims data. METHODS: A retrospective cohort study was conducted of Dana-Farber Cancer Institute (DFCI) patients who died between July 2010 and December 2012, and were insured by Blue Cross Blue Shield of Massachusetts. Primary data sources included Blue Cross Blue Shield of Massachusetts claims information and DFCI administrative data. We assessed NQF-endorsed measures of EOL care related to emergency department visits, hospitalizations, and intensive care unit admissions in the last 30 days, chemotherapy in the last 14 days, hospice stay, and death in an acute care setting. Patterns of care by cancer type and service location were determined. RESULTS: Among 674 patients (mean age 58 years), event rates for NQF-endorsed EOL measures were similar to those reported using Medicare claims. Decedents with hematologic malignancies received significantly more intensive care and were less likely to have enrolled in hospice, compared to decedents with solid tumors. Thirty to 45% of EOL events occurred outside of DFCI and its affiliated hospitals. CONCLUSION: Data sharing between a private payer and a large cancer center proved feasible and informative. High rates of hospital service use outside of our sites of care were unexpected. The findings suggest opportunities to better manage care at the end of life.