"The differences observed across regions and academic medical centers in the approach to caring for patients with chronic illness underscore important opportunities to learn how to improve end-of-life care," said Elliott S. Fisher, MD, report author and co-principal investigator of the Dartmouth Atlas Project, in a media release. "While current trends demonstrate that change is occurring in many regions and at many institutions, it is not always in the direction that patients may prefer."
Fisher, who is also the director of the Center for Population Health at the Dartmouth Institute for Health Care Policy and Clinical Practice, said more work needs to be done "to ensure that future variation in care reflects the well-informed preferences of patients."
The researchers said variations in the treatment of chronically-ill Medicare patients depend largely on the systems of care within different regions and hospitals. For example, declines in the rates of death in a hospital and of death associated with admission to intensive care may also be evidence of attempts to provide care that aligns more closely with many patients' preferences. But not all hospitals changed at the same pace.
Furthermore, the number of ICU days in the last six months of life increased both nationally and in most hospitals and regions; so, too, did the amount of physician labor used.
The full report may be viewed here.