Hospitalizations Up For the Terminally Ill
Additionally, a slightly higher percentage of patients had at least three hospitalizations in the last 90 days between 2000 and 2009.
Teno says the findings surprised her and her team.
"I've spent my entire career as a physician essentially practicing palliative care to improve quality for the seriously ill and dying, but when I saw these results, I said, 'Wow.' I was quite surprised," she says.
Asked if it was possible that families and patients just want providers to do everything possible until the end, Teno says, "There are some families where that may be the explanation. But I think the more predominant thing that's going on here is a kind of 'Don't ask don't tell.' We're not openly communicating with the dying patient and their family about what the treatment options and goals of care are. And I think we can do a better job of that."
Teno adds that the study results are "not surprising when you look at the financial incentives within our fee-for-service healthcare system: We pay (doctors and hospitals) for doing more and we pay for another day in the ICU."
"We don't pay for doctors to have in-depth discussions about the goals of care, or to educate patients about their prognosis, or help them to arrive at treatment goals or develop a plan to honor a dying patients wishes."
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