HealthDay News — According to a study published in the Journal of the American Geriatrics Society, more than one-third of Medicare beneficiaries who died in 2011 had at least four care transitions during their last six months of life.

Shi-Yi Wang, MD, PhD, from Yale University in New Haven, Connecticut, and colleagues evaluated transitions between health care settings (ex hospital, skilled nursing facility, inpatient hospice, home hospice, home without hospice) in the last six months of life among Medicare beneficiaries aged 66 and older who died between July and December 2011. The researchers found that more than 80% of the 660,132 decedents had at least one transition within the last six months of life, with 218,731 individuals having four or more transitions. 

The most frequent transition pattern (19.3% of all decedents) involved four or more transitions (home to hospital, back to home or skilled nursing facility, to hospital again, and then to settings other than hospital).

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There was substantial geographic variation in the average number of transitions in the last six months of life, ranging from 1.8 in Alaska to 3.1 in New Jersey. 

For decedents approaching death, transitions became more intensive. Four or more transitions were more likely in women, blacks, individuals younger than 85 years, and individuals without dementia.

“Identifying interventions that can facilitate care transitions consistent with beneficiaries’ preferences is warranted,” the authors write.

One author disclosed financial ties to the medical device and pharmaceutical industries.


Wang SY, et al. “End-Of-Life Care Transition Patterns Of Medicare Beneficiaries.” Journal of the American Geriatrics Society. 2017. doi: 10.1111/jgs.14891 [Epub ahead of print]

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