Medicare patients with severe chronic illnesses spent fewer days in the hospital while receiving more hospice care in 2007 than they did in 2003. However, those who were hospitalized were likely to see an increase in the intensity of care, according to a new Dartmouth Atlas Project report on trends and variation in end-of-life care.
In 2003, 32 percent of chronically ill patients died in a hospital; by 2007, the rate had dropped to 28 percent. In 2007, the highest rates of death in hospitals were in regions in and around New York City, including Manhattan (45 percent), East Long Island (41 percent) and the Bronx (40 percent). Chronically ill Medicare beneficiaries were less likely to die in a hospital in Minot, N.D. (12 percent of patients); Fort Lauderdale, Fla. (19 percent); and Portland, Ore. (20 percent).
The national rate of deaths associated with admission to intensive care units (ICUs) declined from 19 percent in 2003 to 18 percent in 2007. The likelihood, though, that a patient spent time in an ICU during his or her final hospital admission varied widely in 2007: McAllen, Texas (30 percent), Los Angeles (29 percent), and Miami (29 percent) were among the regions with the highest rates, while Des Moines, Iowa (10 percent), Portland, Ore. (11 percent); and Madison, Wis. (12 percent) were among the regions with the lowest rates.
In addition to its effects on patients' quality of life, "unnecessarily aggressive care carries a high financial cost," said David C. Goodman, MD, lead author and co-principal investigator for the Dartmouth Atlas Project.
About one-fourth of all Medicare spending pays for the care of patients in their last year of life, and "much of the growth in Medicare spending is the result of the high cost of treating chronic disease," Goodman said in a statement. "It may be possible to reduce spending, while also improving the quality of care, by ensuring that patient preferences are more closely followed."
For more information:
- view the Dartmouth study
- see the Robert Wood Johnson Foundation release
- read the Becker Hospital Review article
- see the PBS News Hour article
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