A previous post on this blog (read here) asked whether we're moving closer to identifying exemplary performance in late-life care.
A recent DAI Palliative Care Group analysis of data from the Dartmouth Medical Atlas suggests that palliative care professionals are indeed making a difference in late-life care, at least in some measure.
Our analysts looked at results over a ten-year period from 2004 to 2014, using top 10% of performers as a proxy for exemplars. For example, in 2004, 29.5% of all Medicare deaths occurred in a hospital. That same year, the top 10% performing communities saw fewer than 22.7% of deaths occurring in hospitals. Ten years later, the national average stood at 20.3% (or put another way, average performers were doing 10% better than exemplars 10 years earlier). Meanwhile, exemplar communities were now seeing less than 16.3% of deaths taking place in a hospital.
Almost as impressive is the reduction of inpatient days per decedent in last 6 months of life. In 2004, the average decedent spent 10.9 days in a hospital during last 6 months of life, while exemplary performance weighed in at 7.3 days or fewer. In 2014, average performance was down to 7.9 days (while an improvement of nearly 30% it fell short of reaching exemplar performance of 10 years earlier), and exemplar performance now stood at 5.3 days. Likely, many factors contribute to this improvement, but one cannot underestimate the power of palliative care interventions toward this improvement.
Any measure that did not see significant improvement? Yes, % of decedents spending at least 7 days in ICU during last 6 months of life. Average in 2004 - 14.1%. In 2014 - 13.8%. Meanwhile, in late-life exemplar communities in 2014, only 5.3 % of decedents spend 7 days or more in an ICU during last 6 months. A considerable opportunity for palliative care professionals to once again demonstrate the power of timely palliative interventions to match patient and family preferences with the care they receive.
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