End-of-Life Care is Often Futile, Costly
In a question and answer session on Tuesday, Goodman was asked if there might be some justifiable reasons for these variations.
For example, there may be:
- regional differences in patients' desire for aggressive treatment at the end
- some hospital teams that don't feel their patients' last days can be safely managed at home
- no palliative or hospice care resources in their communities
And it might be that these statistics capture a large percentage of patients who were recently diagnosed, and for whom the futility of care needs time to sink in for both family members and the patients.
Or, for instance, if the patients has dementia, this may not be their decision at all, but may entirely rest with a family member, the doctor, or even a conservator, who may not want to give up care under any circumstances.
While that may have justification in some parts of the country, Goodman says that there's little evidence to suggest that such factors caused such dramatic pivots in the data from one region of the country to the next, or from one hospital system to another.
The Dartmouth Atlas Project's latest work points to the elephant for what it is, and may tilt the discussion about what really is a good use of precious healthcare dollars, just as its work two years ago paved the way for many provisions now embedded in the Affordable Care Act.
Now that this release has put the spotlight on end-of-life treatment and care, I'm hoping these glaring disparities in how quality of care is provided can begin to be addressed by all providers.
We're not talking about letting grandma die here; we're talking about allowing her to have a death with dignity. That death includes care that's high-quality, and helps her maintain a high level of functionality, and one that many of these Medicare patients probably didn't get.
Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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