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51/100

✓ Peer-reviewed alzhub usefulness score 51 out of 100. Getting a diagnosis

Topic: Risk, prevention and care in population studies

Plain-language summary

Background Each year more than 220,000 Medicare beneficiaries receive care from hospice programs designed to enhance the quality of the end of life. Enrollment requires certification by a physician that the patient has a life expectancy of less than six months. We examined how long before death patients enrolled in hospice programs. Methods Using 1990 Medicare claim data, we analyzed the characteristics and survival of 6451 hospice patients followed for a minimum of 27 months with respect to mortality. Results The patients' mean age was 76.4 years; 92.4 percent were white. Half the patients were women, and 80.2 percent had cancer of some type. The most common diagnoses were lung cancer (21.4 percent), colorectal cancer (10.5 percent), and prostate cancer (7.4 percent). The median survival after enrollment was only 36 days, and 15.6 percent of the patients died within 7 days. At the other extreme, 14.9 percent of the patients lived longer than six months. Survival varied substantially according to diagnosis, even after adjustment for age and co-existing conditions. The unadjusted survival after enrollment was shortest for those with renal failure, those with leukemia or lymphoma, and those with liver or biliary cancer; it was longest for those with chronic lung disease, those with dementia, and those with breast cancer. Patients at for-profit, larger, outpatient, or newer hospices lived longer after enrollment than those in other types of hospice programs. Conclusions Most patients who enter hospice care do so late in the course of their terminal illnesses. The timing of enrollment in hospice programs varies substantially with the characteristics of the patients and the hospices.

Cite this study APA, Vancouver, BibTeX · download .bib or .ris

APA 7th

Christakis, N. A., & Escarce, J. J. (1996). Survival of Medicare patients after enrollment in hospice programs. The New England journal of medicine. https://doi.org/10.1056/nejm199607183350306

Vancouver

Christakis NA, Escarce JJ. Survival of Medicare patients after enrollment in hospice programs. The New England journal of medicine. 1996. doi:10.1056/nejm199607183350306. PMID: 8657216.

BibTeX

@article{christakis1996-8657216,
  author  = {Christakis, N. A. and Escarce, J. J.},
  title   = {{Survival of Medicare patients after enrollment in hospice programs}},
  journal = {The New England journal of medicine},
  year    = {1996},
  doi     = {10.1056/nejm199607183350306},
  pmid    = {8657216},
  url     = {https://doi.org/10.1056/nejm199607183350306}
}

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How to read this study

Design: our record does not state a study design, so check the methods section of the original before weighing the result.
Size: the record gives no participant count. Look for one in the original before trusting a pattern.
Effect: the record gives no effect size, so the summary above cannot say how large any difference was.

What the evidence grade means here

This page is graded low. alzhub.org assigns the grade automatically from keywords in the abstract, not from reading the paper. Low means the abstract matched neither pattern. It is the default label, and it does not mean the work is poor; many sound lab and imaging papers land here. It can add at most 5 of the 100 points in the study score, and it is a label about design, not a verdict on whether the findings are true.

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Key findings

Results The patients' mean age was 76.4 years; 92.4 percent were white.

Why it matters

This study examined survival after enrollment in hospice programs among Medicare patients, most of whom had cancer. It is about end-of-life care and survival, not about treating, curing or preventing Alzheimer's disease.

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Study details

Evidence strengthLow

How this study scored 51/100

Published in a top-tier journal. Scored zero for study design, sample size, effect reported, studied in people and randomized / blinded because the record does not state it.

Component	Points	Why
Journal tier	10 / 10	Tier 1 — top-tier general journal (The New England journal of medicine)
Journal's citation record	4 / 4	New England Journal of Medicine: journal h-index 1,505 (OpenAlex, 2026-10-29)
Study design	0 / 12	No study design recorded — scores zero, not guessed (not stated in the record — scored 0)
Strength of evidence	1 / 5	Rated “low” in our summary
Peer-review validation	10 / 10	Peer-reviewed. Published as an article in a named peer-reviewed journal.
How recent	1 / 5	1996 — older than 20 years, still counted
Sample size	0 / 4	Participant count not stated — scores zero (not stated in the record — scored 0)
Effect reported	0 / 3	No effect size reported — scores zero (not stated in the record — scored 0)
Studied in people	0 / 3	Not stated whether this was studied in people — scores zero (not stated in the record — scored 0)
Randomized / blinded	0 / 2	No randomization or blinding stated — scores zero (not stated in the record — scored 0)
Times cited	6 / 7	Cited 544 times (OpenAlex, 2026-10-10)
Citations per year	3 / 5	17.0 citations a year over 32 year(s) since 1996
Impact for its field and year	5 / 6	Cited 31.2× the average for papers of its field and year (OpenAlex FWCI)
Cited by studies here	2 / 6	Cited by 6 other studies in this library
Still being cited	1 / 4	Cited 11 times in 2024–2026 (2026 still in progress; OpenAlex)
Senior author's track record	3 / 4	Last-listed author José J. Escarce: h-index 58 (OpenAlex, whole career)
Institution's track record	2 / 3	University of Pennsylvania: institution h-index 1,859 (OpenAlex)
Multicenter collaboration	1 / 3	OpenAlex lists 3 institution(s) in 1 country
Indexed in PubMed	2 / 2	Indexed in PubMed (PMID 8657216)
Free to read	0 / 2	Behind a paywall — scores zero
Total	51 / 100	—

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