Friday, April 15, 2011

National Healthcare Decisions Day - April 16

This post is part of the 2011 Blog Rally for National Healthcare Decisions Day. If you have a blog please post it and leave it up on the front page through April 16th. -Ed.

Rallying to Encourage and Empower Us All to Make Our Healthcare Decisions Now for the Unknown Later…

College education. Career path. Relationships. Starting a family. Buying or selling a house. Vacations. Retirement. From the age that we’re old enough to understand, most of us are taught and accept that these are the markers in life that we plan for. However, there’s one key marker that’s all-too-often missing from this list: healthcare decision-making. Like planning for these other life events, planning for the time (or times) that we are unable to express our healthcare wishes is of the utmost importance. It is something that should be well thought out, documented and revisited at different points in life to reflect any change in our desires or family situation or the person we wish to advocate for us. Unfortunately, it is a planning point that that majority of us have missed. As a consequence patients’ families suffer the added burden of having to guess when a health crisis happens. That’s why Nathan Kottkamp founded National Healthcare Decisions Day (NHDD) back in 2008 and why this nationwide advance care planning awareness initiative is as important as ever. So this year, I’ve joined my fellow bloggers throughout the country to spread the word about the importance of advance care planning with this special NHDD edition blog.

NHDD, which happens every April 16, is a collaborative effort of national, state and community organizations as well as dedicated individual advocates committed to ensuring that adult Americans – like you and me —have the information and opportunity to communicate and document their healthcare decisions.

 Here are some things you can do for yourself and your loved ones to prepare for NHDD 2011:

Lead by example. Schedule time with your loved ones  to “Have the Talk” and complete your own advance directive. There are many tools, including free forms, you can use to walk you through the process and make your wishes known; access them through the NHDD Public Resources page.

Encourage your loved ones and friends to learn more about advance directives and to complete their advance directives. You can forward this link: to them. Or, encourage them to find a nearby participant and attend a local NHDD event.

Share your advance directive with your healthcare providers and make sure it is on file in the event it is needed.

Already had the conversation with your loved ones, but want to do more? Here a few suggestions to rally support for NHDD and encourage even more action:

Like the NHDD Facebook fan page and share it with your Facebook friends

On Twitter? Follow @NHDD and share the information with your followers.
Send an email to your friends, staff, colleagues, lodge/social club members, and/or house of worship, telling them that you are participating in NHDD and encouraging them to do the same. Share the information above with them and/or use this template email:

April 16 is National Healthcare Decisions Day, and I hope that you will join me in taking this time to discuss and document your healthcare wishes. We all need to be prepared in the event of a health crisis, and having the talk is easier than most people think, but many of us need a little inspiration or a reminder to do it. I hope that this message and National Healthcare Decisions Day are all you need. Please mark your calendar for April 16 to have the talk with your loved ones. There are all sorts of free resources, including free advance directive forms for each of the 50 states, on the NHDD website: Additionally, please help me spread the word with Twitter, Facebook, and LinkedIn. Advance care planning is something we ALL should do and encourage others to do, regardless of age or current health. Discussing your wishes can be one of the most important gifts you ever give your loved ones.

Act now and grow this rally further: use and share the resources available through the NHDD website and encourage and empower us all to make our healthcare decisions now for the unknown later.

Wednesday, April 13, 2011

Variations in Late-Life Care Persist - What Can Be Done? And By Whom?

A recent blog post commented on the enormous clinical variation in late-life care. Another blog post remarked on the difficulty of "spreading the science of palliative care" because of the fragmented system delivering palliative care. And this week The Dartmouth Atlas Project  issued a study - "Trends and Variation in End-of-Life Care for Medicare Beneficiaries with Severe Chronic Illness" - which further documented the enormous clinical variations across the nation as late-life (final six months) care is provided. The differences among communities is staggering, and these variations persist. For example, in 2007, chronically-ill patients in Manhattan spent, on average, 20.6 days in the hospital during their last six months of life, almost four times more than patients in Ogden, UT, where the average was 5.2 days. Chronically ill patients in Fort Lauderdale were half as likely to die in a hospital than similar patients in and around New York City. Is there a question as to which region's late-life care practices better comply with patient and family preferences?
The report documents trends from 2003 to 2007 in the use of medical resources to treat Medicare patients at the end of life at hospital referral regions and at 94 academic medical centers. The study found that Medicare patients diagnosed with severe chronic illness were less likely to die in a hospital and more likely to receive hospice care. They also had many more visits from physicians, particularly medical specialists, and spent more days in ICUs. The overall picture, one could say, is mixed; although patients experienced fewer hospital days and more hospice care, at the same time therre was an increase in the intensity of care for patients who were hospitalized.

"In addition to its effects on patients' quality of life, unnecessarily aggressive care carries a high
financial cost. About one-fourth of all Medicare spending goes to pay for the care of patients in their last year of life, and much of the growth in Medicare spending is the result of the high cost of treating chronic disease," said David C. Goodman, MD, lead author of the report, in a media release. Elliott S. Fisher, MD, report author and co-principal investigator of the Dartmouth Atlas Project, perhaps put it best, "While current trends demonstrate that change is occurring in many regions and at many institutions, it is not always in the direction that patients may prefer." Dr. Fisher went on to say more work needs to be done "to ensure that future variation in care reflects the well-informed preferences of patients."

Chronically ill patients were significantly more likely to be treated by 10 or more doctors in the last six months of life in 2007 than they were in 2003. Visiting such a number of physicians certainly must place a premium on effective care transitions. Is our current system well structured to enable effective and coordinated patient transitions?

Future posts on this blog will take a closer look at the findings of this Dartmouth study, and examine those regions, and academic medical centers, that may offer promising approaches. In other words, we'll identify exemplars.

We need to be better at disseminating the science and art of palliative care to reduce these clinical variations. But how to do that, and who should be leading the effort? Should we take a closer look at a national campaign to improve late-life care, like the 30/30/30 Campaign described in a previous post on this blog. Your thoughts are invited.