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National Report Shows Wide Variation in End of Life Care

Recently, the Dartmouth Atlas project released the first-ever comprehensive report on end of life care for patients with advanced cancer. To do this, researchers identified 235,821 Medicare beneficiaries who died from cancer and analyzed ten specific measures of care in the last month of life at academic and private hospitals throughout every region of the United States.

The results were surprising in how clearly they demonstrated a large variation in end of life care for cancer patients. For example, the percent of patients admitted to intensive care varied more than sevenfold across hospital referral regions. The use of hospice care also varied markedly. At some institutions, more than 75% were admitted to hospice in the last month of life, whereas less than half of patients received hospice services in the last month of life in more than 50 academic centers.

The authors conclude that their data clearly suggest that every hospital system could do better in end of life care. They allude to research that shows that physicians often fail to inform patients about prognosis and treatment options such as hospice despite evidence that patients want to hear this information. Although the report did not directly measure patient and family preferences, there are strong published data that more than 80% of patients wish to die at home. They also suggest that the wide variation in care practices are not because of evidence-based practice, but rather a result of local patterns of care and supply – i.e. more hospitals equates to more hospital admissions. The authors suggest that all hospitals examine their utilization measures from this data and determine if their practice reflects the current best practice model for end of life care: educating patients about prognosis, eliciting choices in care, and forming care plans that respect the patient’s goal of care.

So how did Froedtert Hospital (FH) do? In most of the measures, FH performed much better than the national average. This could be attributed to the hard work and success garnered from MCW and FH’s Palliative Care Center in improving the end of life care for patients in our community over the last 15 years.

Read the table below to compare FH’s results with national averages.

 

% dying in a hospital

% admitted to a hospital in last month of life

% admitted to an ICU in last month of life

% receiving life-sustaining treatments at last month of life

% enrolled in hospice in last month of life

FH

19.6%

63.2%

18.7%

6.7%

66.2%

National Average with Ranges

29%
(7-47%)

61%
(44-78%)

24%
(13-42%)
 

9%
(2.7-18%)

55%
(19-83%)


Article written by Sean Marks, MD, Division of Palliative Care

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© 2014 Medical College of Wisconsin
Page Updated 01/10/2012