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>  News Releases >   2004 >   March

No consistency in end-of-life care among top hospitals

Dartmouth College Office of Public Affairs • Press Release
Contact Megan Cooper (603) 650-1971 or (603) 448-1871

New study shows large variations, even among the most prestigious hospitals, in end-of-life medical care

Even among the nation's top hospitals, there are vast differences in the amount and type of health care given to patients in the final months of life, according to a new study by Dartmouth Medical School researchers. The results highlight the fact that decisions about end-of-life care are more a matter of individual institutional practice than a response to what patients want or need, said the study's lead authors, Dr. John E. Wennberg and Dr. Elliott S. Fisher.

"We knew from our previous research that the amount of care a patient receives varies widely from region to region and is typically driven by the availability of hospital resources, not by evidence-based standards of practice. This study shows that practices vary even among hospitals rated as 'excellent' providers of care, and even among similar hospitals within the same city. That is to say, hospitals deliver a level of care more related to the number of beds and specialists available than to what is likely to improve the end of life," said Fisher, a Dartmouth Medical School Professor of Medicine and Director of the Veterans Affairs Medical Center Outcomes Group in White River Junction, Vt.

The study, published in the March 13 issue of the British Medical Journal, used Medicare data from 77 highly regarded academic medical centers around the United States to examine how much care similarly ill patients received in the last six months of life. In particular, researchers compared the average number of days patients spent as hospital inpatients and in intensive care, as well as the number of physician visits and the percentage of patients seeing more than 10 physicians during their last six months of life. After adjusting for age, sex and illness, the researchers found that the intensity of care during the last six months of life and at the time of death varied substantially, even among hospitals in the same region. Time spent in the hospital ranged from less than 10 days to 27 days, and time in intensive care units ranged from less than two days to almost 10 days.

The percentage of deaths occurring in hospitals ranged from less than 16 percent to more than 55 percent, and the percentage of deaths associated with a stay in intensive care ranged from less than 9 percent to more than 36 percent.

Previous studies by the same research group have demonstrated that where a patient lives predicts much about the care he or she receives for most common medical conditions such as heart disease and diabetes. Their research has also shown that simply receiving more health care does not result in better life expectancy.

Note for editors and reporters: Data specific to the hospitals included in the study is available by contacting Megan Cooper at the phone number or email address listed above.

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