Dartmouth Atlas Area‐Level Estimates of End‐of‐Life Expenditures: How Well Do They Reflect Expenditures for Prospectively Identified Advanced Lung Cancer Patients?

Objective

Assess validity of the retrospective Dartmouth hospital referral region () end‐of‐life spending measures by comparing with health care expenditures from diagnosis to death for prospectively identified advanced lung cancer patients.

Data/Setting/Design

We calculated health care spending from diagnosis (2003–2005) to death or through 2011 for 885 patients aged ≥65 years with advanced lung cancer using Medicare claims. We assessed the association between Dartmouth ‐level spending in the last 2 years of life and patient‐level spending using linear regression with random effects, adjusting for patient characteristics.

Findings

For each $1 increase in the Dartmouth metric, spending for our cohort increased by $0.74 ( < .001). The Dartmouth spending variable explained 93.4 percent of the ‐level variance in observed spending.

Conclusions

‐level spending estimates for deceased patient cohorts reflect area‐level care intensity for prospectively identified advanced lung cancer patients.