Healthcare Utilization at the End of Life
http://www.medscape.com/viewarticle/449340_11
Nursing Research
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.
|
