Aggressive end-of-life care rises

Tools

More patients are dying at home than in the hospital, in accordance with their wishes, while the use of hospice and hospital palliative care services grows, according to a study in this month's Journal of the American Medical Association.

But the news isn't all good: Researchers found increased intensive care unit use and a higher rate of healthcare transitions during the last month of life, suggesting highly aggressive end-of-life care.

Looking at more than 800,000 Medicare beneficiaries, researchers found that while the proportion of deaths in acute care hospitals dropped from 32.6 percent in 2000 to 24.6 percent in 2009, ICU stays in the last 30 days of life rose from 24.3 percent to 29.2 percent, according to a research announcement.

And despite embracing hospice care, more people are using hospice for only three days or less. What's more, nearly one-third of those short hospice stays followed a hospitalization and ICU stay in the last month of life. Such findings indicate that increased hospice use may not mean lower healthcare resource utilization.

Healthcare transitions in the last three days of life increased from 10.3 percent to 14.2 percent in 2009. Sending patients near death from a hospital bed to the ICU to hospice care can create agitation, disorientation and medication disruption, PoliticoPro reported.

The findings highlight problems with fee-for-service financial incentives and end-of-life care, HealthLeaders Media reported.

"We don't pay for doctors to have in-depth discussions about the goals of care or to educate patients about their prognosis, or help them to arrive at treatment goals or develop a plan to honor a dying patients wishes," lead author Joan M. Teno of the Warren Alpert Medical School of Brown University told HealthLeaders.

On top of financial deterrents, patients' end-of-life preferences often are left out of medical records, making it difficult for providers to know about and follow them, FierceEMR previously reported.

For more:
- here's the JAMA study and announcement
- read the PoliticoPro article
- read the HealthLeaders Media article

Related Articles:
Palliative care offers return on investment
Hospice enrollment policies may turn away high-cost patients
Palliative care moves beyond hospital setting
Hospice care in ACOs reduces hospitalizations