Dying patients are more likely to receive less intense medical care than in the recent past. The cost of that healthcare, however, provided by hospitals, physicians, and hospice, continues to rise, says a Dartmouth Atlas report.
Terminally ill patients received less aggressive interventions and were more likely enrolled in hospice in their last six months if they died in 2010 than if they died in 2007, according to the latest Dartmouth Atlas report on end-of-life care.
Patients dying in 2010 also were less likely to spend a portion of their last days in the hospital, and were less likely to die in one than in 2007. For example, in 2007, 28.1% of patients died in an acute care setting; in 2010, 25% were in a hospital when they expired. And fewer episodes of terminal care involved time spent in an intensive care unit, from 17.6% in 2007 to 16.7% in 2010.
"The surprise was the rapidity of change that we saw nationally and in individual healthcare systems," says David Goodman, MD, co-principal investigator of the Dartmouth Atlas Project.
For example, the University of Pittsburgh Medical Center "in a three-year –period had a 20% reduction in inpatient days in the last six months life, and 16% reduction in intensive care unit days," he says. And Fletcher Allen Health Care in Burlington, VT, "which already had a very low intensity of care in 2007, one of the lowest in the country, still reduced [its] inpatient days by 22%."