No particular type of hospital provides care for cancer patients that is more consistent with National Quality Forum-endorsed measures, such as lower rates of intensive-care unit use in the last month of life or receiving hospice care for fewer than three days, according to a new study in the April issue of the journal Health Affairs.
Cancer care varies widely among similar hospital types: study
Researchers from the Dartmouth Institute for Health Policy & Clinical Practice analyzed data of more than 215,000 Medicare patients with poor-prognosis cancer—meaning they were likely to die within a year—at about 4,400 hospitals across the country from 2003 to 2007.
The researchers focused on the care provided to patients in the six months before their death, such as hospitalizations, ICU use, hospice use and the number of physicians who provided care, and compared the care among different types of facilities, including community hospitals, academic medical centers, for-profit and not-for-profit hospitals, and those facilities with a special cancer-care designation.
The findings showed that, generally, a high volume of inpatient services were delivered at the end of a patient's life and that care varied considerably among similar facilities. But no type of hospital provided care that was more consistent with NQF measures that include having lower rates of ICU use in the last month of life, chemotherapy in the last 14 days of life, death in a hospital, receiving hospice care for fewer than three days, and higher rates of hospice use in the in the last month of life.
“Each hospital needs to examine the care it provides to patients believed to be nearing death, and question its alignment with patient preferences—whether they be for early supportive care or aggressive treatment in the last days of life,” the authors concluded.
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