{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T05:36:51Z","timestamp":1768282611272,"version":"3.49.0"},"reference-count":43,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,2,29]],"date-time":"2024-02-29T00:00:00Z","timestamp":1709164800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100005227","name":"Centers for Medicare and Medicaid Services","doi-asserted-by":"publisher","award":["75FCMC19D0091\/75FCMC20F0001"],"award-info":[{"award-number":["75FCMC19D0091\/75FCMC20F0001"]}],"id":[{"id":"10.13039\/100005227","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess the effects of the Medicare Care Choices Model (MCCM) on disparities in hospice use and quality of end\u2010of\u2010life care for Medicare beneficiaries from underserved groups\u2014those from racial and ethnic minority groups, dually eligible for Medicare and Medicaid, or living in rural areas.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Sources and Study Setting<\/jats:title><jats:p>Medicare enrollment and claims data from 2013 to 2021 for terminally ill Medicare fee\u2010for\u2010service beneficiaries nationwide.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Through MCCM, terminally ill enrolled Medicare beneficiaries received supportive and palliative care services from hospice providers concurrently with curative treatments. Using a matched comparison group, we estimated subgroup\u2010specific effects on hospice use, days at home, and aggressive treatment and multiple emergency department visits in the last 30\u2009days of life.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Collection\/Extraction Methods<\/jats:title><jats:p>The sample included decedent Medicare beneficiaries enrolled in MCCM and a matched comparison group from the same geographic areas who met model eligibility criteria at time of enrollment: having a diagnosis of cancer, congestive heart failure, chronic obstructive pulmonary disease, or HIV\/AIDS; living in the community; not enrolled in the Medicare hospice benefit in the previous 30\u2009days; and having at least one hospital stay and three office visits in the previous 12\u2009months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Principal Findings<\/jats:title><jats:p>Eligible beneficiaries from underserved groups were underrepresented in MCCM. MCCM increased enrollees' hospice use and the number of days at home and reduced aggressive treatment among all subgroups analyzed. MCCM also reduced disparities in hospice use by race and ethnicity and dual eligibility by 4.1 (90% credible interval [CI]: 1.3\u20136.1) and 2.4 (90% CI: 0.6\u20134.4) percentage points, respectively. It also reduced disparities in having multiple emergency department visits for rural enrollees by 1.3 (90% CI: 0.1\u20132.7) percentage points.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>MCCM increased hospice use and quality of end\u2010of\u2010life care for model enrollees from underserved groups and reduced disparities in hospice use and having multiple emergency department visits.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1475-6773.14289","type":"journal-article","created":{"date-parts":[[2024,2,29]],"date-time":"2024-02-29T08:09:28Z","timestamp":1709194168000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The Medicare Care Choices Model was associated with reductions in disparities in the use of hospice care for Medicare beneficiaries with terminal illness"],"prefix":"10.1111","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9005-9054","authenticated-orcid":false,"given":"Matthew J.","family":"Niedzwiecki","sequence":"first","affiliation":[{"name":"Mathematica  Washington DC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0643-9263","authenticated-orcid":false,"given":"Lauren Vollmer","family":"Forrow","sequence":"additional","affiliation":[{"name":"Mathematica  Cambridge Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6073-8902","authenticated-orcid":false,"given":"Jonathan","family":"Gellar","sequence":"additional","affiliation":[{"name":"Mathematica  Washington DC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4272-1434","authenticated-orcid":false,"given":"R. Vincent","family":"Pohl","sequence":"additional","affiliation":[{"name":"Mathematica  Washington DC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8065-4025","authenticated-orcid":false,"given":"Arnold","family":"Chen","sequence":"additional","affiliation":[{"name":"Mathematica  Princeton New Jersey USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8722-1919","authenticated-orcid":false,"given":"Lynn","family":"Miescier","sequence":"additional","affiliation":[{"name":"Center for Medicare &amp; Medicaid Innovation, Centers for Medicare &amp; Medicaid Services  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9230-5906","authenticated-orcid":false,"given":"Keith","family":"Kranker","sequence":"additional","affiliation":[{"name":"Mathematica  Washington DC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,2,29]]},"reference":[{"key":"e_1_2_8_2_1","volume-title":"What Are Palliative Care and Hospice Care?","author":"National Institute on Aging","year":"2021"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjspcare-2015-001001"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/1049909118820494"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/0269216318815794"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1000678"},{"key":"e_1_2_8_7_1","volume-title":"Views and Experiences with End\u2010of\u2010Life Medical Care in the U.S. 2017","author":"Hamel L","year":"2017"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12904\u2010016\u20100077\u20108"},{"key":"e_1_2_8_9_1","unstructured":"Hospice Care. 42 CFR \u00a7418.2023https:\/\/www.ecfr.gov\/current\/title-42\/chapter-IV\/subchapter-B\/part-418"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.2147\/CIA.S2811"},{"key":"e_1_2_8_11_1","volume-title":"March 2023 Report to the Congress: Medicare Payment Policy","author":"Medicare Payment Advisory Commission (MedPAC)","year":"2023"},{"key":"e_1_2_8_12_1","volume-title":"Percentage of Patients Who Died from Cancer Admitted to Hospice for Less than 3\u2009Days","author":"National Quality Forum","year":"2016"},{"key":"e_1_2_8_13_1","volume-title":"2022 National Healthcare Quality and Disparities Report","author":"Agency for Healthcare Research and Quality (AHRQ)","year":"2023"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30569-X"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2021.01394"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMms2025396"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.13030"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.13108"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.1919"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.16648"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2007.0216"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.14269"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.14639"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2022.03.017"},{"key":"e_1_2_8_25_1","volume-title":"Hospice Through the DEI Lens","author":"National Hospice and Palliative Care Organization (NHPCO)","year":"2022"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951519000403"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1177\/1049909114565658"},{"key":"e_1_2_8_28_1","volume-title":"Palliative Care Projects: Synthesis of Evaluation Results 2012\u20132021","author":"Center for Medicare & Medicaid Innovation","year":"2022"},{"key":"e_1_2_8_29_1","unstructured":"Brooks\u2010LaSureC FowlerF SeshamaniM TsaiD.Innovation at the Centers for Medicare and Medicaid Services: a vision for the next 10\u2009years. 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