Dartmouth Atlas: Costs Rise for Medicare Patients at End of Life

John Commins, for HealthLeaders Media , April 13, 2011
The report found that:
  • From 2003 to 2007, the percentage of chronically ill patients dying in hospitals and the average number of days they spent in the hospital before their deaths declined in most parts of the country and at most academic medical centers. In 2003, 32.2% of patients died in a hospital; by 2007, the rate had dropped to 28.1%. In 2007, the highest rates of hospital deaths were in and around New York City, including Manhattan (45.8%), East Long Island (41.9%) and the Bronx (39.9%). Chronically ill patients were far less likely to die in a hospital in Minot, ND (12%), Fort Lauderdale, FL (19%) and Portland, OR (19.6%).
  • For patients using academic medical centers for most of their care, rates of hospital deaths also dropped. Several hospitals that had among the lowest rates in 2003 saw substantial decreases over the five-year period; one example is University of Utah Health Care in Salt Lake City, where the rate dropped from 31.5% to 21.3%. In comparison, in 2003, UCLA Medical Center and the Medical College of Georgia in Augusta had very similar rates, at 39.1% and 39.7%, respectively. Over five years, their rates moved in opposite directions. UCLA joined medical centers with the highest rates at 45.5%, while the rate at the Medical College of Georgia dropped to 28.7%.
  • Overall, the average patient spent slightly fewer days in the hospital during the last six months of life in 2007 than in 2003. The national rate dropped from 11.3 to 10.9 hospital days per patient. In 2007, chronically-ill patients in Manhattan spent, on average, 20.6 days in the hospital during their last six months of life, almost four times more than patients in Ogden, UT, where the average was 5.2 days.
  • Those academic medical centers where patients spent less time in the hospital in 2007 than in 2003 included the University of Texas Medical Branch Hospitals in Galveston (-5.0 days), the University of Iowa Hospitals and Clinics in Iowa City (-5.0 days) and Tufts-New England Medical Center in Boston (-4.6 days). Ten academic medical centers had increases of at least two days, including Hahnemann University Hospital in Philadelphia (+6.8 days).
  • Chronically ill patients were significantly more likely to be treated by 10 or more doctors in the last six months of life in 2007 than they were in 2003, as the national rate increased from 30.8% to 36.1%. In 2007, patients in Royal Oak, MI received the most intensive care by this measure, with 58.1% of patients seeing 10 or more doctors in the last six months of life. Other regions with high rates included Ridgewood, NJ (57.6%) and Philadelphia (57.2%). Regions with low rates included Boise, ID (14.2%), Salt Lake City (15.0%) and Medford, OR (16.4%).
  • From 2003 to 2007, among the 35 academic medical centers for which data are available, 22 had increases in the percentage of patients seeing 10 or more doctors in the last six months of life. Emory University Hospital saw the largest growth in this rate, from 40.4% to 63.2%, while the University of North Carolina Hospitals in Chapel Hill had the largest decrease, from 45% to 35.2%. In 2003, the likelihood that a patient at Emory University Hospital would see 10 or more doctors was similar to that for a patient at the University of North Carolina Hospitals. Over the next five years, the percentage of patients seeing 10 or more doctors increased 22.8 percentage points at Emory, while the percentage dropped 9.8 percentage points at UNC Hospitals.


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