Iowans see better end-of-life care

Study shows better Medicare patient care during last six months of life

Published: June 22 2013 | 7:00 am - Updated: 28 March 2014 | 4:55 pm in
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A new report that looks at the quality, outcomes and cost for Medicare beneficiaries with chronic illnesses at the end of their lives shows improvements in care.

The Dartmouth Atlas Project report found that these patients spent fewer days in the hospital and received more hospice services in 2010 compared to 2007. Two officials, including the study's lead researcher, said dying patients spending less time in a hospital being seen by numerous physicians equates to better end of life care.

In the Iowa City region, for example, 11 percent of deaths included an ICU admission.

The findings were released June 12 by the Dartmouth Institute for Health Policy & Clinical Practice.

The report and accompanying data brief looked at the number of deaths among chronically ill patients; total Medicare spending per patient during the last two years of life; intensive-care-unit days per patient; and all physician visits per patient, among other categories.

An Iowa City health official said she was encouraged to see more patients are getting the benefit of hospice, even if it is only for a short time.

"What's concerning about these numbers is the degree to which we are still having patients see sub-specialists," said Ann Broderick, director of Palliative Medicine at the University of Iowa Hospitals and Clinics. "They're having ICU time in their last six months to a year."

David Goodman, co-director of the Dartmouth Atlas Project in Lebanon, N.H., said patient experiences and making sure patients get the type of care they prefer are the most important takeaways from the data.

"Iowa generally has lower hospital use for Medicare beneficiaries than many other parts of the country," he said. "That's both for initial admissions to the hospital as well as care of patients with chronic illness at the end of life.

"For this population, patients on average strongly prefer to spend time in homelike environments as close to family and friends whenever possible, so it's more likely that patients in Iowa are receiving the care that they prefer."

Researchers also looked at other categories, including the total Medicare spending during the last two years of life. Five of the top 18 regions in the country where Medicare spent the least amount person person during their last two years of life are in Iowa — Dubuque (fourth), Mason City, Sioux City, Iowa City (16th) and Des Moines.

Cedar Rapids ranked 42nd.

The average cost Medicare spent on patients in the Iowa City region in 2010 was $52,047. For lower cost care, a patient would have to go to Minot, N.D., the cheapest location.

According to the analysis of more than 300 regions nationwide, a chronically ill patient is far less likely to die in a hospital in Dubuque than in Los Angeles, Calif. In 2010, 15.2 percent of chronically ill patients died in a hospital in Dubuque, compared with 33.9 percent in Los Angeles.

Data also compared the average number of inpatient days spent in the last six months of life in Iowa with the national average. Iowa hospitals vary between 6.2 and 7.5, compared to the national average of 9.9, he said.

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