Trajectories at the end of life: A controlled investigation of longitudinal Health Services Consumption data.

BACKGROUND: Knowledge of individual-level trajectories of Health Services Consumption (HSC) at End-of-Life (EoL) is scarce. Such research is needed for understanding and planning health expenditures.

OBJECTIVE: To explore individual-level EoL trajectories in the Israeli population. This approach differs from past studies which aggregated across populations or disease groups.

DATA SOURCES: We used HMO (Health Maintenance Organization) longitudinal data for HSC of persons ages 65-90 who died during 2010-2011 (n=35,887) and of an age by sex matched sample of persons who were alive by mid-2012 (n=48,560).

DESIGN: HSC per quarter was calculated for each individual. Trajectory-types of HSC were described through k-means cluster analysis.

EXTRACTION METHODS: Data were extracted from computerized HMO files. HSC was computed as a standardized function of HMO costs for each individual.

RESULTS: In both samples, low HSC trajectories were the most common. However, among the deceased, all trajectories had higher HSC than those who were alive; the low HSC trajectory cluster represented a smaller percentage of the sample; and all relevant trajectories included a HSC peak. In contrast, the most common trajectory among the living was a flat low HSC. Clusters differed significantly by sex, disease status, and age.

CONCLUSION: This methodology shows the utility of individual-level analysis of HSC at end-of-life and should inform future research and current debates concerning EoL care and resource distribution.