Health Care Utilization—We examined health care utilization at the EOL, which was
defined as hospitalizations and outpatient visits in the year prior to death or from the time
from HF diagnosis until death if less than one year. The date of death was determined using
death certificates filed in Olmsted County, obituary notices, and electronic files of death
certificates obtained from the State of Minnesota Department of Vital and Health Statistics.
Cause of death was obtained from death certificates; cardiovascular cause of death was
defined by International Classification of Diseases 10th revision codes I01-I99. Information
on hospitalizations and outpatient visits in Olmsted County was obtained from the Olmsted
County Healthcare Expenditure and Utilization Database4, 20. Transfers between hospitals
were considered a single hospitalization. The primary reason for admission was categorized
as cardiovascular (ICD-9 codes 390-459) or non-cardiovascular (all other codes) based on
principal ICD-9 code. Outpatient visits were categorized by provider type (cardiologist vs.
non-cardiologist). As we were unable to identify provider type for some visits in the county
after July 1, 2010, this analysis was restricted to patients that died prior to that date. Tests,
imaging and outpatient procedures were not counted as outpatient visits and were not
quantified.
Health Care Utilization—We examined health care utilization at the EOL, which wasdefined as hospitalizations and outpatient visits in the year prior to death or from the timefrom HF diagnosis until death if less than one year. The date of death was determined usingdeath certificates filed in Olmsted County, obituary notices, and electronic files of deathcertificates obtained from the State of Minnesota Department of Vital and Health Statistics.Cause of death was obtained from death certificates; cardiovascular cause of death wasdefined by International Classification of Diseases 10th revision codes I01-I99. Informationon hospitalizations and outpatient visits in Olmsted County was obtained from the OlmstedCounty Healthcare Expenditure and Utilization Database4, 20. Transfers between hospitalswere considered a single hospitalization. The primary reason for admission was categorizedas cardiovascular (ICD-9 codes 390-459) or non-cardiovascular (all other codes) based onprincipal ICD-9 code. Outpatient visits were categorized by provider type (cardiologist vs.non-cardiologist). As we were unable to identify provider type for some visits in the countyafter July 1, 2010, this analysis was restricted to patients that died prior to that date. Tests,imaging and outpatient procedures were not counted as outpatient visits and were notquantified.
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