Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Site of Death & Patterns of Care in Older Adults

JAMA; ePub 2018 Jun 25; Teno, Gozalo, et al

Among Medicare beneficiaries who died in 2015 compared with 2000, there was a lower likelihood of dying in an acute care hospital, an increase and then stabilization of intensive care unit (ICU) use during the last month of life, and an increase and then decline in health care transitions during the last 3 days of life. This according to a retrospective cohort study among a 20% random sample of 1,361,870 decedents who had Medicare fee-for-service and a 100% sample of 871,845 decedents who had Medicare Advantage and received care at an acute care hospital, at home or in the community, at a hospice inpatient care unit, or at a nursing home. Researchers found:

  • The proportion of deaths that occurred in acute care hospitals decreased to 19.8%.
  • ICU use during the last 30 days of life increased and then stabilized at approximately 29%.
  • Health care transitions during the last 3 days of life increased and then decreased after 2009.


Teno JM, Gozalo P, Trivedi AN, et al. Site of death, place of care, and health care transitions among US Medicare beneficiaries, 2000-2015. [Published online ahead of print June 25, 2018]. JAMA. doi:10.1001/jama.2018.8981.

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