Study Finds Differences in End-of-Life Care Across California, U.S.
The national project measured the intensity of end-of-life care by the amount of time that dying patients spent in the hospital and the aggressiveness of physician services during that time.
The report found that dying patients across the U.S.Â are spending fewer days in the hospital and more time in hospice care.
However, patients who are hospitalized are receiving more aggressive end-of-life care, with more physician visits and greater reliance on high-cost intensive care units.
According to the report, residents in the San Francisco Bay Area were about twice as likely to die in a high-cost, high-tech intensive care unit as people in Portland, Ore. or Minot, N.D.
However, Bay Area residents were far less likely to be treated in an intensive care unit than residents in Manhattan.
The report found thatÂ the CaliforniaÂ regions with the highest percentage of advanced cancer patients who received end-of-life care in hospitals were:
- Los Angeles County, with 41%;
- Fresno, with 39%;
- Bakersfield, with 37%;
- San Francisco, with 36%; and
- Modesto, with 36%.
The report also found major differences in end-of-life care costs within cities. For example, Medicare spent $23,000, or one-third, more per patient in the last two years of life at Regional Medical Center than at Good Samaritan Hospital -- which are 15 miles apart -- because of different care strategies.
Response to Findings
Judy Citko -- director of the Coalition for Compassionate Care in California -- said end-of-life care is becoming more aggressive because "[p]eople are living longer with more chronic conditions, and there are more things that the health care system can do."
Maribeth Shannon of the California HealthCare Foundation -- which publishes California Healthline -- discussed the difference in end-of-life care between San Francisco and Los Angeles. She said, "In the San Francisco Bay Area, where hospitals are fuller, we see less intensive care than in L.A., where beds are readily available."
Meanwhile, critics of the project argued that its analysis of patients who died following end-of-life treatments ignored patients who are still alive as a result of aggressive care from physicians.Supporters of the project responded that the data bring critical attention to hospitals' tendency to "do everything" during end-of-life treatment, which can prolong suffering or dying, according to the Mercury News (Krieger, San Jose Mercury News, 12/9). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.