Medicare patients with chronic illness spent fewer days in the hospital and were less likely to die in the hospital in 2007 than in 2003, according to a report by the Dartmouth Atlas Project.
The report examined regional and hospital-specific variations in the medical care provided to Medicare beneficiaries with one or more chronic illnesses at the end of life.
Other key findings from the report:
- The use of hospice care for these patients increased from 2003 to 2007 in almost all regions of the country
- Among the same patients, there was a rise in the number of ICU days in the last six months of life
- Trends in end-of-life care from 2003 to 2007 differed substantially across regions and academic medical centers. For example, the change in the percentage of hospital deaths ranged from a sharp decrease at some hospitals to a substantial increase at others.
- There was variation in measures of end of life care. In 2007, the percentage of deaths in hospital varied by a factor of almost four across hospital referral regions, and the average number of hospice days per patient in the last six months of life varied by a factor of more than six.
The authors conclude that the differences observed across both regions and academic medical centers in the approach to caring for patients with serious chronic illness underscore important opportunities to learn how to improve end-of-life care.