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      An economic examination of private insurance claims among adolescents and young adults who were enrolled in hospice during the last year of life

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          Abstract

          Purpose

          The purpose of this study was to generate baseline data on the health characteristics, health care utilization, and health care spending among privately insured adolescents and young adults (AYA), who were enrolled in hospice care during their last year of life.

          Methods

          A retrospective, nonexperimental design was used to collect and analyze longitudinal claims data from the Truven Health MarketScan™ database. The sample included AYA (aged 15–24 years) who utilized hospice during their last year of life.

          Results

          Totally, 17,408 AYA were included in this analysis. Mean hospice length of stay (LOS) was low overall, but there was a statistically significant difference in hospice LOS in ages 15–19 years (mean 3.56, SD 15.17 days) compared with those aged 20–24 years (mean 2.26, SD 8.24; P<0.001 days). More than a third (37%) of the AYAs used the emergency department during the last year of life and 83% sought care from a primary care visit. However, only 6% of the sample who were hospice enrollees used frequent inpatient hospital services.

          Conclusions

          This study provides preliminary data for private insurance expenditures and clinical utilization for AYA who were enrolled in hospice. This analysis also provides initial evidence to suggest extremely short hospice LOS for AYAs prior to the end of life and represents an area of future research need.

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          Most cited references17

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          Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation

          Background The pediatric complex chronic conditions (CCC) classification system, developed in 2000, requires revision to accommodate the International Classification of Disease 10th Revision (ICD-10). To update the CCC classification system, we incorporated ICD-9 diagnostic codes that had been either omitted or incorrectly specified in the original system, and then translated between ICD-9 and ICD-10 using General Equivalence Mappings (GEMs). We further reviewed all codes in the ICD-9 and ICD-10 systems to include both diagnostic and procedural codes indicative of technology dependence or organ transplantation. We applied the provisional CCC version 2 (v2) system to death certificate information and 2 databases of health utilization, reviewed the resulting CCC classifications, and corrected any misclassifications. Finally, we evaluated performance of the CCC v2 system by assessing: 1) the stability of the system between ICD-9 and ICD-10 codes using data which included both ICD-9 codes and ICD-10 codes; 2) the year-to-year stability before and after ICD-10 implementation; and 3) the proportions of patients classified as having a CCC in both the v1 and v2 systems. Results The CCC v2 classification system consists of diagnostic and procedural codes that incorporate a new neonatal CCC category as well as domains of complexity arising from technology dependence or organ transplantation. CCC v2 demonstrated close comparability between ICD-9 and ICD-10 and did not detect significant discontinuity in temporal trends of death in the United States. Compared to the original system, CCC v2 resulted in a 1.0% absolute (10% relative) increase in the number of patients identified as having a CCC in national hospitalization dataset, and a 0.4% absolute (24% relative) increase in a national emergency department dataset. Conclusions The updated CCC v2 system is comprehensive and multidimensional, and provides a necessary update to accommodate widespread implementation of ICD-10.
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            Health status of adolescent and young adult cancer survivors.

            Adolescents and young adults (AYA) ages 15 to 29 years who are diagnosed with cancer are at risk for long-term morbidity and mortality associated with treatment of their cancer and the cancer itself. In this article, the authors describe the self-reported health status of AYA cancer survivors. The authors examined 2009 data from the Behavioral Risk Factor Surveillance System, including demographic characteristics, risk behaviors, chronic conditions, health status, and health care access, among AYA cancer survivors compared with respondents who had no history of cancer. The authors identified 4054 AYA cancer survivors and 345,592 respondents who had no history of cancer. AYA cancer survivors, compared with respondents who had no history of cancer, reported a significantly higher prevalence of current smoking (26% vs 18%); obesity (31% vs 27%); chronic conditions, including cardiovascular disease (14% vs 7%), hypertension (35% vs 29%), asthma (15% vs 8%), disability (36% vs 18%), and poor mental health (20% vs 10%) and physical health (24% vs 10%); and not receiving medical care because of cost (24% vs 15%). AYA cancer survivors commonly reported adverse behavioral, medical, and health care access characteristics that may lead to poor long-term medical and psychosocial outcomes. Increased adherence to established follow-up guidelines may lead to improved health among AYA cancer survivors. Copyright © 2012 American Cancer Society.
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              Palliative Care Involvement Is Associated with Less Intensive End-of-Life Care in Adolescent and Young Adult Oncology Patients.

              Adolescent and young adult oncology (AYAO) patients often receive intensive medical care and experience significant symptoms at the end of life (EOL).
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                Author and article information

                Journal
                Adolesc Health Med Ther
                Adolesc Health Med Ther
                Adolescent Health, Medicine and Therapeutics
                Adolescent Health, Medicine and Therapeutics
                Dove Medical Press
                1179-318X
                2018
                30 August 2018
                : 9
                : 117-120
                Affiliations
                [1 ]Department of Acute and Specialty Care, School of Nursing, University of Virginia, Charlottesville, VA, USA, Jlk2t@ 123456virginia.edu
                [2 ]Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, VA, USA, Jlk2t@ 123456virginia.edu
                [3 ]Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
                [4 ]College of Nursing, University of Tennessee-Knoxville, Knoxville, TN, USA
                Author notes
                Correspondence: Jessica Keim-Malpass, School of Nursing, University of Virginia, P.O. Box 800782, Charlottesville, VA 22908-0782, USA, Tel +1 434 243 3961, Email Jlk2t@ 123456virginia.edu
                Article
                ahmt-9-117
                10.2147/AHMT.S168501
                6122891
                fb42b0d6-df52-4e56-9813-1488c3c12889
                © 2018 Keim-Malpass et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Categories
                Short Report

                adolescent,young adult,hospice,economic,private health insurance,end of life

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