Tuesday, November 16, 2010

Dartmouth study of EOL Quality

David Goodman and colleagues at the Dartmouth Atlas have a new report "Quality of End of Life Cancer Care for Medicare Beneficiaries" out today that shows large variation in the types of care that Medicare beneficiaries receive when they are very ill with Cancer. Most persons think of this issue as only being linked to access to aggressive therapy, but a key issue is access to palliative care which seeks to improve quality of life, and hospice care that is team based palliative care for those believed to be very near death. They document tremendous differences in access to palliative care and outcomes that are believed to be against the wishes of many patients, such as dying in the hospital. The Dartmouth researchers believe that if patients and families better understood their prognosis and their choices, that many would not opt for the same patterns of care that are commonly observed.

A few related items:
  • Here is the link to the study I did with colleagues at Duke showing that hospice reduce Medicare expenditures by around $2,300 in the last year of life as compared to normal care that is being noted in some news stories in conjunction with this report. Note that hospice and palliative medicine focus on improving quality of life, but have often been found to reduce costs as well.
  • Here is a link to a Health Affairs blog post I wrote with Amy Abernethy noting that while health care costs aggregate near the end of life, it will be hard to reduce health expenditures a great deal by focusing on end of life (how close people are to death) as the locus of trying to intervene to reduce expenditures. In large part, this is because it can be hard to figure out how close someone is to death. We called EOL savings the Fools Gold of health reform. A more fruitful line of policy is to systematically ask whether care improves quality of life and/or extends life. If you do this, it will almost certainly reduce costs near the end of life, but it is a much more productive line of policy.
  • Here is some in depth discussion on my blog of the Temel et al. paper published in the NEJM in August that shows that palliative care improved quality of life, reduced costs and extended life for patients with stage 4 lung cancer....and me wondering if it had been out one August earlier if the preposterous death panel stuff would have been avoided. Nah, probably not. Igor Volsky with new post that would seem to suggest one more study wouldn't have made a difference, at least not with one Senator who was at the heart of the 'pull the plug' nonsense.

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