Tracking Improvement in the Care of Chronically Ill Patients

A Dartmouth Atlas Brief on Medicare Beneficiaries Near the End of Life

The care patients receive near the end of life has changed dramatically in recent years. Patients and their families are now increasingly working with their doctors to choose whether they will spend their final days in an intensive care unit (ICU), in hospice care, or at home.

A new brief from the Dartmouth Atlas Project examines how the care that chronically ill patients received at the end of life changed among hospitals and regions from 2007 to 2010. Overall, Medicare patients in the last six months of life spent fewer days in the hospital and received more hospice care in 2010 than they did in 2007, while time spent in ICUs remained about the same. Spending on these Medicare patients increased more than 15 percent from 2007 to 2010.

The trends across regions and hospitals show that in 2010, compared to 2007, patients were:

•        Less likely to be in the hospital during the last six months of life;

•        More likely to be enrolled in hospice care during the last six months of life;

•        Less likely to die in the hospital;

•        More likely to see more than 10 physicians during the last six months of life; and

•       Just as likely to spend time in intensive care units (ICUs) during the last six months of life, with virtually no change from 2007 to 2010.

This report shows rapid improvement in many places, although patients in some hospitals continue to receive more aggressive and less palliative care than others.”

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