|
Abstract:
|
This project aims to evaluate the effect of utilization of hospice care on medical cost among end-of-life patients. The existing literature has focused on comparing patients who utilized hospice versus who did not, adjusting for (e.g. through matching) patient characteristics. However, arguably such an approach fails to take into account of several important sources of confounding, including physicians' attitude towards hospice and the timing of patients' entry to hospice. Additionally, the number of days a patient lives after assignment is a post-treatment outcome and hence, ideally, should not be used in matching. Here, we provide a framework to draw valid causal inferences that address these complications. We will define the treatment as physician's recommendation; we treat patient's hospice care utilization as a confounded post-treatment variable, and use Principal Stratification to draw causal inference. We will also develop a Bayesian statistical model/algorithm to estimate a summary score of patients' health status and thus "eligibility" to hospice based on electronic health record data. We will apply the methodology to the Medicare claims records with
|
