Claims/utilization-based intensity of end-of-life (EOL) cancer care in integrated health systems (IHS).

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230 Background: Little is known about the intensity of EOL cancer care for patients within IHS or those under 65 years of age. This study assessed achievement of National Quality Forum (NQF) benchmarks for EOL cancer care among IHS enrollees aged >20 at death. Methods: Using methods described by Earle, we identified IHS enrollees whose cause of death was cancer (not diagnosed at death or via autopsy) per tumor registry data between 2000-2008. Using claims/utilization data we identified individuals who received chemotherapy (chemo) in the last 14 days of life (C, benchmark (B): <10%) or a new chemo regimen in the last 30 days of life (NC, B<2%); had >1 emergency department visit (ER, B<4%):) or hospitalization (H, B<4%) in the last 30 days of life; died in hospital (HD, B: <17%), were not admitted to hospice (NH, B: <45%), or where admitted to hospice in the last 3 days of life (SH, B: <8%). The percentages were then compared to previously established fee-for-service (FFS) Medicare benchmarks. Results: At death, 4,924 IHS cancer patients were >65 years of age, 3,478 were <65. For those >65, benchmarks were achieved for chemo in the last 14 days of life (5%), death in an acute care hospital (16%), and hospice stay <3 days (4%). For those aged 21-64 years of age at death, benchmarks were achieved for chemo in the last 14 days of life (7%) and hospice stay <3 days (4%). Benchmarks were not achieved in either group for new chemo regimens, ER visits, or hospitalizations in the last 30 days of life or hospice admissions. Conclusions: Most NQF benchmarks for EOL cancer care were not achieved, particularly among the young. Future research should update FFS benchmarks based on current utilization and clarify benchmarks for those <65. Final presentation will include results from at least 2 other IHS. [Table: see text]