Primary Care Physician Continuity And End-Of-Life Care Intensity Among Medicare Cancer Decedents.

38Background: While continuity with one’s primary care physician (PCP) care may be expected to reduce the intensity of end-of-life care, evidence to date has been inconclusive. Methods: Using the Surveillance, Epidemiology, and End Results–Medicare database, we identified 63,269 decedents who were diagnosed with cancer during the years 2004-2011, had at least 4 PCP visits within the year prior to cancer diagnosis, and died within 6-36 months of diagnosis. Care continuity was defined as having at least one outpatient visit within 6 months of cancer diagnosis by the PCP who saw the patient most frequently in the year before cancer diagnosis. Measures of intensive end-of-life care included chemotherapy received within 14 days of death, u003e 1 emergency department (ED) visit, u003e 1 hospitalization, ≥ 1 intensive care unit (ICU) admission or no hospice enrollment within 30 days of death. Using hierarchical generalized linear models, we examined the associations between care continuity and end-of-life care patterns,...