The latest report finds that while intensity of care declined overall, dying patients were more likely to have more than 10 outpatient physician visits during the last six months of life in any setting, including in the hospital, a sign that care at the end of life is increasingly fragmented among multiple clinicians who may not be communicating well with each other, Goodman says.
However, patients' chance of spending time in the intensive care did not change. Patients dying in 2010 spent on average nearly three days longer in hospice care, 21 days, compared with 18.3 in 2007.
Also disappointing is the report's finding that regional trends persist, because at hospitals in about 18 states, practices to encourage more appropriate care for terminally ill patients have stagnated or become even more intense rather than less.
That's shown by a measurement the Dartmouth Atlas project refers to as the "hospital care intensity index" for each hospital referral region, state, and hospital. The Atlas is based on 1.1 million Medicare patients who died in 2010, and 1.16 who died in 2007.
The index is a composite of various healthcare services at the end of life such as time spent in a hospital or an ICU, number of physician visits, enrollment in hospice, use of imaging, home health services, ambulance services, durable medical equipment, and whether the patient died during a hospital stay.