First Analysis of the
Differences in Treatment and Costs of End-of-Life Care Among Developed
Countries Shows Room for Improvement Across the Board
Newswise, January 21, 2016 – Despite widespread perception, the United
States does not provide the worst end-of-life care in the world.
In the first
international comparison of end-of-life care practices, researchers from the Perelman School of Medicine at
the University of Pennsylvaniaand colleagues from seven countries found
that the United States actually has the lowest proportion of deaths in the
hospital and the lowest number of days in the hospital in the last six months
of life among the those countries, according to a new study published today in JAMA.
However, the United States performs
poorly in other aspects of end-of-life care, especially related to
high-technology interventions.
Over 40 percent of patients who die with cancer
are admitted to the intensive care unit (ICU) in the last six months of life,
which is more than twice that of any other country in the study. Similarly, 39
percent of American patients dying with cancer received at least one
chemotherapy treatment in the last six months of life more than any other
country in the study.
Using data from 2010 to 2012,
researchers compared the site of death, treatments, and care used, as well as
hospital expenses during the last six months of life for 389,073 patients who
died in seven countries: Belgium, Canada, England, Germany, the Netherlands,
Norway and the U.S.
In Belgium and Canada over 50 percent of patients died in
the hospital, while in England, Norway, and Germany over 38 percent of patients
died in the hospital. By comparison in the U.S. 22 percent, and in the
Netherlands 29 percent of cancer patients died in the hospital, which is in
accordance with most patients’ wishes.
“There’s a widespread perception
that the U.S. spends a tremendous amount on end-of-life care, but until now
there’s never been a comparative study to put U.S. spending and resource
utilization in context,” said senior author Ezekiel J. Emanuel, MD, PhD, Vice Provost for Global
Initiatives, the Diane vS. Levy and Robert M. Levy University Professor, and
chair of the Department of Medical Ethics and Health Policy at Penn.
“End-of-life care is intensive and expensive, and what we know now is that the
US does not have the worst end-of-life care and that no country is optimal. All
countries have deficits.”
Spending on end-of-life care was
high in the U.S. at about $18,500 for hospital care in the last six months of
life. Canada and Norway were even higher at $21,840 and $19,783 per patient,
respectively, while Belgium, England, and the Netherlands were lower at
$15,699, $9,342, and $10,936, respectively.
Importantly, these results suggest
reasons for optimism, suggests Emanuel: “Care for patients dying with cancer
has improved. As the U.S. shows it is possible to change care. In the early
1980s over 70 percent of patients with cancer died in the hospital and spending
many days in the hospital was common. We can improve care and now countries
need to commit to improving that care.”
“Every country has its own
challenges to improve end-of-life care. There are still too many people with
cancer dying in acute care hospitals when we know our patients prefer to die at
home,” said Justin E. Bekelman, MD, an associate professor of Radiation
Oncology and Medical Ethics and Health Policy, and lead author of the new
study.
“The U.S. continues to have high rates of ICU admissions and other
markers of care intensity near the end of life. We can do better. We need a
concerted effort toward making end-of-life care more consistent with our
patients’ wishes.”
Using the results of this paper as a
baseline for end-of-life care in the U.S. compared to other countries, the
authors say moving forward it will be important for studies to focus on the
cost of care outside of the hospital and better understanding the drivers of
health care utilization disparities.
“This study focuses only on patients
with cancer and mainly on their hospital services,” Emanuel said.
“To really
understand the costs and to develop new models for improved delivery of
end-of-life care, we need a prospective study to evaluate three things: dying
patients with other diseases, the full range of care both in and out of the
hospital, and most importantly, the quality of that care.”
The study was funded by the National
Institute on Aging (P01-AG19783), the National Cancer Institute (KO7CA163616),
and the Commonwealth Fund (20130502).
Penn Medicine is one of the
world's leading academic medical centers, dedicated to the related missions of
medical education, biomedical research, and excellence in patient care.
Penn
Medicine consists of the Raymond and Ruth Perelman School of Medicine at
the University of Pennsylvania(founded in 1765 as the nation's first medical
school) and the University of Pennsylvania Health System, which together
form a $5.3 billion enterprise.
The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 17 years, according to U.S. News & World Report's survey of research-oriented medical schools.
The School is
consistently among the nation's top recipients of funding from the National
Institutes of Health, with $409 million awarded in the 2014 fiscal year.
The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center -- which are recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report -- Chester County Hospital; Lancaster General Health; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751.
Additional affiliated inpatient care facilities and services throughout the
Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn
Partners, a partnership between Good Shepherd Rehabilitation Network and Penn
Medicine.
Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2014, Penn Medicine provided $771 million to benefit our community.
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