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Healthcare Utilization at the End of Life

Nursing Research

from Medscape Nurses

Mukamel DB, Bajorska A, Temkin-Greener H. Health care services utilization at the end of life in a managed care program integrating acute and long-term care. Medical Care. 2002;40:1136-1148.

Care at the end of life, consuming more than 10% of national healthcare expenditures, often brings a marked increase in health resource utilization from treatment choices made by both patients and physicians. Managed care programs such as the Program for All-Inclusive Care for the Elderly (PACE) seek to integrate long-term planning with acute care needs, emphasizing community-based services and the implementation of advance directives to tailor end-of-life care to the needs and desires of the patient. To examine healthcare utilization patterns for patients approaching the end of life, researchers analyzed routine assessment data from 2160 PACE participants in 10 different sites over the 3 years preceding their deaths. Over most of the study period, healthcare expenditures averaged roughly $2600 per month for services including primary care, nursing home stays, social services and home care, and rehabilitation. This figure begins to rise at 7 months prior to death, and reaches more than $5800 in the final month, mostly from increases in acute care, nursing home use, and hospitalization. Resource use varied significantly by site, indicating that some care choices depend on regional influences. Identifying optimal end-of-life care can improve health resource utilization patterns to both lower costs and enhance patient choice.