Hospitals make varied progress on end-of-life care

A new report shows Medicare patients have experienced improvements in end-of-life care, with chronically ill beneficiaries in their last six months of life spending fewer days in the hospital and receiving more hospice services in 2010 than in 2007.

The Dartmouth Atlas brief, released Wednesday, looked at more than 1 million claims for Medicare patients who died in 2010, and found that in only three years, hospital days per patient dropped 9.5 percent while deaths occurring in the hospital fell 11 percent.

Meanwhile, hospice enrollment increased by 13.3 percent and the average number of hospice days rose by 15 percent.

"The growing use of hospice care and decrease in hospital use at the end of life are promising trends that may reflect attempts to provide care that aligns more closely with patients' preferences," David C. Goodman, M.D., M.S., Dartmouth Atlas co-principal investigator, said in a statement.

While there appears to be a trend toward less hospital care for terminally ill patients, the news isn't all good: During the last six months of life, Medicare patients were more likely to see more than 10 physicians and were just as likely to spend time in intensive care units in 2010 compared to 2007.

The brief also found uneven progress among hospitals; some hospitals showed signs of rapid development in end-of-life care and others made minimal improvement.

The reasons behind why patients in some hospitals continue to receive more aggressive and less palliative care than others remain unknown, although Dartmouth researchers attribute the varied pace of advances in end-of-life care to where patients live and receive care.

The brief adds to February research in the Journal of the American Medical Association, which found more patients are dying at home than in the hospital, in accordance with their wishes. The study also found an increase in hospice and hospital palliative care services, although a higher rate of healthcare transitions during the last month of life suggests highly aggressive end-of-life care remains a problem.

For more:
- here's the Dartmouth Atlas announcement and study (.pdfs)