End-of-Life Care is Often Futile, Costly

Cheryl Clark, for HealthLeaders Media , November 18, 2010


  • Why do three Medicare cancer patients spent their last 30 days in an intensive care unit on average nationally, but that varied from 6% in Mason City IA to 41% in McAllen, TX.


    In a question and answer session on Tuesday, Goodman was asked if there might be some justifiable reasons for these variations.

    For example, there may be:

    • regional differences in patients' desire for aggressive treatment at the end
    • some hospital teams that don't feel their patients' last days can be safely managed at home
    • no palliative or hospice care resources in their communities

    And it might be that these statistics capture a large percentage of patients who were recently diagnosed, and for whom the futility of care needs time to sink in for both family members and the patients.

    Or, for instance, if the patients has dementia, this may not be their decision at all, but may entirely rest with a family member, the doctor, or even a conservator, who may not want to give up care under any circumstances.

    While that may have justification in some parts of the country, Goodman says that there's little evidence to suggest that such factors caused such dramatic pivots in the data from one region of the country to the next, or from one hospital system to another.

    The Dartmouth Atlas Project's latest work points to the elephant for what it is, and may tilt the discussion about what really is a good use of precious healthcare dollars, just as its work two years ago paved the way for many provisions now embedded in the Affordable Care Act.

    Now that this release has put the spotlight on end-of-life treatment and care, I'm hoping these glaring disparities in how quality of care is provided can begin to be addressed by all providers.

    We're not talking about letting grandma die here; we're talking about allowing her to have a death with dignity. That death includes care that's high-quality, and helps her maintain a high level of functionality, and one that many of these Medicare patients probably didn't get.

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    Comments are moderated. Please be patient.

    4 comments on "End-of-Life Care is Often Futile, Costly"

    Karl Vanhooten (11/19/2010 at 11:49 AM)
    One comment: MDs and hospitals get paid (by somebody) whether grandma dies or not. And the more they do to her, the more they can charge.

    The Ratings Guy (11/19/2010 at 8:27 AM)
    First of all, this was a sampling of 20% of Medicare cases. Secondly they only looked at those who died...so yes I guess ALL care would have been FUTILE. If you want to drink Dartmouth's Kool Aid, you will have to believe that providers are all evil, uninformed and stupid. This sampling never had any contact with the patients, so ALL of the commentary about what patients wanted or knew is conjecture. We all know that bad stuff happens at death, and Dartmouth has done nothing to inform anyone about how to manage or predict it any better. This is another example of spin coming out of the Dartmouth Working Group. Let me guess...and all of the patients expired too, wow, what a finding!

    John Rosenstock (11/19/2010 at 7:09 AM)
    Patrick doesn't have a clue as to what he is saying. It's not really the money being spent (alhough that has a side benifit) it's the futility of the treatment which is often painful and futile instead of having a peaceful death at home or in hospice with family and/or friends present. To die in the ICU hooked to life support is never peaceful and comfortable.




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