More patients utilizing hospice services and choosing to die at home over past decade

Feb 5^th– JAMA – The number of patients dying in acute care hospitals declined from 32.6% in 2000 to 24.6% in 2009.

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1. The number of patients dying in acute care hospitals declined from 32.6% in 2000 to 24.6% in 2009.

2. The use of hospice services doubled from 21.6% in 2000 to 42.2% in 2009.

3. The time in an intensive care unit over the last 30 days of life and health care transitions over the last 3 days of life have also increased from 2000 to 2009.

The study indicates that deaths in acute care hospitals have decreased, while ICU admissions and healthcare transitions have increased in the last decade. In past surveys, most people in the United States have indicated a preference to die at home; thus, the place of an individual’s death has become increasingly considered as a marker of quality at the end-of-life. However, this measure fails to recognize the multiple healthcare transitions, either from home to hospice or hospice to the intensive care unit, that occur in the months preceding death.

As the study examines a random sampling of a large number of Medicare beneficiaries, it provides a good perspective on end of life care in the studied population. It should be noted that the study retrospectively analyzes data from Medicare registries and database information and that the interpretation of the data analyses remain speculation in the absence of prospective studies to examine the true effects of health care transitions and ICU stays. Nonetheless, the study provides a compelling argument that healthcare providers should indeed strive to honor the wishes of patients if they desire to die at home but should recognize this as only one aspect of quality at the end-of-life. Moving forward, it will be critical to eliminate unnecessary health care transitions according to the patient’s goals of care elicited by a thoughtful and timely conversation that can include access to symptomatic, emotional, and religious supports during the end-of-life phase of patients.

Click to read the study in JAMA

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1. The number of patients dying in acute care hospitals declined from 32.6% in 2000 to 24.6% in 2009.

2. The use of hospice services doubled from 21.6% in 2000 to 42.2% in 2009.

3. The time in an intensive care unit over the last 30 days of life and health care transitions over the last 3 days of life have also increased from 2000 to 2009.

This [retrospective, cohort] study: This study looked at a random 20% sample of Medicare patients aged 66 and over who died in 2000 (n= 270,202), 2005 (n= 291,819), and 2009 (n= 286,282). Over the past decade, a lower proportion of patients died in acute care hospitals (32.6% vs. 24.6%) while more chose to die at home (30.7% vs. 33.5%). Over the course of the same time, more patients required intensive care stays near the end of life (24.3% vs. 29.2%) and consequently had an increased rate of health care transitions (number of places of care) in the last days of life (10.3% vs. 14.2%). Approximately 45.5% of late referrals to hospice care came from acute care hospitals contributing to the increase in healthcare transitions.

In sum: The study indicates that deaths in acute care hospitals have decreased, while ICU admissions and healthcare transitions have increased in the last decade. In past surveys, most people in the United States have indicated a preference to die at home; thus, the place of an individual’s death has become increasingly considered as a marker of quality at the end-of-life. However, this measure fails to recognize the multiple healthcare transitions, either from home to hospice or hospice to the intensive care unit, that occur in the months preceding death.

As the study examines a random sampling of a large number of Medicare beneficiaries, it provides a good perspective on end of life care in the studied population. It should be noted that the study retrospectively analyzes data from Medicare registries and database information and that the interpretation of the data analyses remain speculation in the absence of prospective studies to examine the true effects of health care transitions and ICU stays. Nonetheless, the study provides a compelling argument that healthcare providers should indeed strive to honor the wishes of patients if they desire to die at home but should recognize this as only one aspect of quality at the end-of-life. Moving forward, it will be critical to eliminate unnecessary health care transitions according to the patient’s goals of care elicited by a thoughtful and timely conversation that can include access to symptomatic, emotional, and religious supports during the end-of-life phase of patients.

Click to read the study in JAMA

By Brittany Hasty and Rif Rahman

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