Use of hospitals, physician visits, and hospice care during last six months of life among cohorts loyal to highly respected hospitals in the United States

Wennberg, John E.; Fisher, Elliott S.; Stukel, Thérèse A.; Skinner, Jonathan; Sharp, Sandra M.; Bronner, Kristen K.

doi:10.1136/bmj.328.7440.607

Cited by 264 publications

(201 citation statements)

References 18 publications

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“…Future efforts to understand these demographic differences in hospice use should focus on patients with other cancers. Similar to other studies, 9,10,19,20,22 we found that women living in urban areas were more likely than women in rural areas to enroll in hospice, and we found significant variation by geographic area. Focused efforts to understand how patients, physicians, and hospices interact at the local level may be important to understand better the reasons for these area-level variations; our study suggests that future studies must also consider patients' interactions with physicians and hospitals.…”

Section: Discussionsupporting

confidence: 79%

Care in the Months before Death and Hospice Enrollment Among Older Women with Advanced Breast Cancer

et al. 2007

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Section: Discussionsupporting

confidence: 79%

Care in the Months before Death and Hospice Enrollment Among Older Women with Advanced Breast Cancer

et al. 2007

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“…Such undesired variability may decrease system reliability (introducing avoidable opportunity for error), 26 and lead to under-use of needed therapies as well as overuse of unnecessary therapies. 1 Our work extends prior research that has identified wide variation in patterns of hospital admission, use of hospital resources, and processes of inpatient care, [27][28][29][30][31][32] by documenting reported variation in the use of common inpatient therapies. Rates of hospital admission may vary by as much as 7-fold across regions.…”

Section: Discussionsupporting

confidence: 62%

Variation in pediatric hospitalists' use of proven and unproven therapies: A study from the Pediatric Research in Inpatient Settings (PRIS) network

Landrigan

Conway

Stucky

et al. 2008

Journal of Hospital Medicine

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BACKGROUND:Undesirable practice variation remains a major concern with the quality of the healthcare system. While care in pediatric hospitalist systems has been demonstrated to be efficient, neither the quality of care nor determinants of variation in pediatric hospitalist systems are well understood.OBJECTIVE:To measure variation in pediatric hospitalists' reported use of common inpatient therapies, and to test the hypothesis that variation in reported use of proven therapies is lower than variation in reported use of unproven therapies.DESIGN AND MEASUREMENTS:We conducted a survey of pediatric hospitalists in the US and Canada. Respondents reported their frequency of using 14 therapies in the management of common conditions. Each therapy was determined to be of proven or unproven effectiveness using published critical appraisals. Variation in reported use of proven and unproven therapies was compared.RESULTS:67% (213/320) of surveyed individuals participated. Little variability existed in reported use of albuterol and corticosteroids in asthma (4‐6% of respondents reported not often using them) and systemic dexamethasone in bronchiolitis (12% of respondents reported using it more than rarely). Moderate to high variation existed in reported use of all other therapies studied. Variation in reported use of proven therapies was significantly less than variation in reported use of unproven therapies (15.5 ± 12.5% vs. 44.6 ± 20.5%).CONCLUSIONS:Substantial variation exists in hospitalists' reported management of common pediatric conditions. Variation is significantly lower for strongly evidence‐based therapies. To decrease undesirable variation in care, a stronger evidence base for inpatient pediatric care must be built. Journal of Hospital Medicine 2008;3:292–298. © 2008 Society of Hospital Medicine.

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“…48 We derived and externally validated our model at two tertiary-care medical centers in New York City, where utilization of acute care in the last 6 months of life is greater than at other major medical centers in the United States. 49 Our model still needs to be validated in community hospitals and in other geographic regions where case mix and patient care may differ.…”

Section: Discussionmentioning

confidence: 99%

A Prognostic Model for 6-Month Mortality in Elderly Survivors of Critical Illness

Baldwin¹,

Narain²,

Lederer³

et al. 2011

Chest

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A dults older than 65 years of age now comprise more than one-half of all ICU admissions in the United States. 1 Approximately 1.4 million elderly (aged Ն 65 years) Medicare benefi ciaries are discharged each year after receiving intensive care. 2 With technological advances, many critically ill elderly adults now survive what were previously fatal illnesses, 3,4 but outcomes can be poor. Among the 33% of elderly ICU patients discharged to skilled-care facilities, nearly one-half are rehospitalized and 25% to 65% die within 6 months. 2,5 While predictive models exist for ICU survivors of prolonged mechanical ventilation and elders hospitalized without intensive care, 6,7 there are no existing clinical prediction tools to help predict outcome explicitly for elderly ICU survivors. A validated prediction model for postdischarge mortality in elderly ICU survivors could (1) risk-stratify patients for clinical trials of novel preventative, rehabilitative, and therapeutic interventions; (2) help determine appropriate levels of postacute care; and (3) aid providers in addressing expectations and end-of-life care with these patients and their families.We aimed to derive and externally validate a prediction model for 6-month mortality among elderly ICU survivors. We hypothesized that including markers of frailty and disability as well as patient preferences regarding resuscitation in our model would be important in predicting 6-month mortality. Withholding life-supporting therapies often indicates

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Use of hospitals, physician visits, and hospice care during last six months of life among cohorts loyal to highly respected hospitals in the United States

Abstract: Objective To evaluate the use of healthcare resources during the last six months of life among patients of US hospitals with strong reputations for high quality care in managing chronic illness. Design Retrospective cohort study based on claims data from the US Medicare programme.

Cited by 264 publications

References 18 publications

Care in the Months before Death and Hospice Enrollment Among Older Women with Advanced Breast Cancer

Care in the Months before Death and Hospice Enrollment Among Older Women with Advanced Breast Cancer

Variation in pediatric hospitalists' use of proven and unproven therapies: A study from the Pediatric Research in Inpatient Settings (PRIS) network

A Prognostic Model for 6-Month Mortality in Elderly Survivors of Critical Illness

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