Patient-Provider Relationships and Disparities in End-of-Life Care Among Medicare Beneficiaries: Methodological Approaches Using the Medicare Current Beneficiary Survey

• Activity Number: 645
• Type: Contributed
• Date/Time: Thursday, August 13, 2015 : 8:30 AM to 10:20 AM
• Sponsor: Government Statistics Section
• Author(s): Jennifer Hasche* and Kirk Wolter and Sai Loganathan and Kevin Koenig and Debra Reed-Gillette and Paul Guerino and Chris Haffer
• Companies: NORC at the University of Chicago and NORC at the University of Chicago and NORC at the University of Chicago and NORC at the University of Chicago and Centers for Medicare and Medicaid Services and Centers for Medicare and Medicaid Services and Centers for Medicare and Medicaid Services
• Keywords: Medicare ; CMS ; panel design ; survey weights ; end-of-life

Abstract

The Medicare Current Beneficiary Survey (MCBS) is a continuous, multi-purpose survey of a nationally representative sample of the Medicare population, conducted by the Centers for Medicare and Medicaid Services (CMS). The MCBS employs a rotating-panel design, in which each annual sample ("panel") is introduced in the fall and sampled beneficiaries are interviewed at four-month intervals for up to four years. Cross-sectional survey weights are available annually for the entire MCBS sample, and "backward looking" longitudinal weights are available for the surviving sample in a given year. Our objective is to assess whether the patient-provider relationship is a mediating factor contributing to racial and ethnic differences in quality of end-of-life EOL care and expenditures for the sample of community and facility-dwelling respondents who died between 2008 and 2010 (sample N=1,672). We examine issues surrounding 1) the proper specification of the domain analysis and 2) the appropriate use of weights and calculation of standard errors to adjust for the unaccounted negative correlation across years associated with beneficiaries' deaths.