Hospitals and physicians could improve their treatment of chronically ill Medicare patients near the end of their life by focusing more on patients' wishes and needs, concluded the authors of a new study for the Dartmouth Atlas Project.
Focus more on patient wishes with end-of-life care: study
Researchers for Dartmouth studied Medicare data for patients in the last six months of their lives and found significant variance within regions and among academic medical centers, indicating that care is not being applied in a uniform way and some providers are doing a better job than others.
“It raises questions about whether this care is aligned with patients' preferences,” said David Goodman, lead author and co-principal investigator for the Dartmouth Atlas and director of the Center for Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice, in a teleconference for reporters. Surveys indicate that patients wish to receive less-aggressive care in favor of being able to have a higher quality of life in their last days, and those providers who are more aggressive with care may not be addressing those wishes, according to Dartmouth Atlas researchers.
In the study, the average patient spent 10.9 days in the hospital during the last six months of life in 2007, compared with 11.3 in 2003. In 2003, 32.2% of patients in the last six months of their life died in a hospital; by 2007, the rate had dropped to 28.1%, according to Dartmouth. The average number of hospice days per patient in the last six months of life increased to 18.3 days from 12.4 days.
Meanwhile, 36.1% were treated by 10 or more physicians in 2007, compared with 30.8% in 2003. The average number of days in intensive care increased from 3.5 in 2003 to 3.8 in 2007.
Send us a letter
Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.