End-of-Life Care for Medicare Patients Changing

Patients in hospital less but hospice more; care has become more intense

TUESDAY, April 12 (HealthDay News) -- Care for chronically ill Medicare patients at end-of-life changed between 2003 and 2007, with patients spending less time in the hospital and more time in hospice care, and care also grew more intense during that five-year period, according to a new Dartmouth Atlas Project report.

David C. Goodman, M.D., of the Dartmouth Institute for Health Policy and Clinical Practice in Hanover, N.H., and colleagues with the Dartmouth Atlas Project updated previously published findings of regional variations in end-of-life care and documented trends in the use of medical resources for the treatment of Medicare beneficiaries at the end-of-life from 2003 to 2007.

The researchers found that health care is changing the way seriously and chronically ill patients are treated, and that there are striking differences in the pace of change from one region to another. Overall, patients experienced fewer days in the hospital and more hospice care at the end of the period versus the beginning, while there was an increase in visits from physicians, particularly medical specialists, and also more days spent in intensive care units.

"In addition to its effects on patients' quality of life, unnecessarily aggressive care carries a high financial cost. About one-fourth of all Medicare spending goes to pay for the care of patients in their last year of life, and much of the growth in Medicare spending is the result of the high cost of treating chronic disease," Goodman said in a statement. "It may be possible to reduce spending, while also improving the quality of care, by ensuring that patient preferences are more closely followed."

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