Docs More Likely to Use Hospice, ICU/CCU at End of Life
U.S. physicians were more likely to use hospice and intensive or critical care units at end of life compared to non-physicians, a new study in the Journal of the American Geriatrics Society has shown.
Earlier studies have brought to light that many interventions offered towards the end of life may be of "little value" with higher spending tied to poorer quality of death. Studies have also highlighted existing gaps in care for patients with life-limiting illness, including the lack of prognostic understanding and not addressing care goals and preferences. Currently, medical literature supports the hypothesis that physicians may die differently than non-physicians. It is not clear whether actual healthcare use varies between physicians and non-physicians.
The retrospective observational cohort study examined fee-for-service Medicare beneficiaries across the country using Medicare Part A claims data between 2008–2010 for 9,947 deceased physicians and a random cohort of 192,006 Medicare decedents. The claims data were used to measure days in the hospital and the proportion using hospice in the final 6 months of life as primary outcome measures adjusted for socio-demographic characteristics and regional variations in healthcare.
Study authors found no difference in the rate of hospitalization in the last 6 months of life between physicians and non-physicians although more physicians used hospice and for a longer duration: hospital use: odds ratio [OR] 0.98, 95% CI: 0.93-1.04; hospital days: mean difference 0.26; P=0.14; dying in the hospital (OR 0.99, 95% CI=0.95–1.04); intensive care unit (ICU) or critical care unit (CCU) days: mean difference 0.35 more days for physicians, P<0.001); using hospice: OR 1.23, 95% CI: 1.18–1.29; number of days in hospice: mean difference 2.06, P<0.001).
Although the study is impacted by unmeasured confounders and variation in coding practices, the findings provide evidence that physicians were more likely to use hospice and intensive or critical care unit-level care. Daniel Matlock, MD, MPH, lead author of the study, noted that the findings raise concerns that the "high utilization seen at the end-of-life is a larger, systems issue."
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