Quality and costs of end-of-life care: the need for transparency and accountability.

@article{Teno2014QualityAC,
  title={Quality and costs of end-of-life care: the need for transparency and accountability.},
  author={Joan M. Teno and Pedro L Gozalo},
  journal={JAMA},
  year={2014},
  volume={312 18},
  pages={1868-9}
}
Increasing attention to the quality of end-of-life care for seriously ill, dying adults has included evaluation of the site of death, place of care, and health care transitions1 with an important concern being whether these patterns of c are, especially receipt of aggressive care, is consistent with patient preferences and improved quality of life. Choices involving these and other aspects of end-of-life care, such as for hospice care, are complex decisions that involve patients, their families… CONTINUE READING

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While the majority of hospice programs are of high quality , there is a significant minority for which there is emerging evidence of concerns , such as increasing rates of hospice live discharges , hospice patients at home who are not visited by professional staff in the last days of life , and for - profit hospice programs that are less likely to provide discretionary or noncore hospice services than nonprofit programs.4 - 7 Dying patients are a vulnerable population and often are impoverished , frail , older , and cognitively impaired.8 As both private insurers and Medicare change the financial incentives in health care from doing “ more ” to “ less , ” there is an increased need for transparency and accountability .
While the majority of hospice programs are of high quality , there is a significant minority for which there is emerging evidence of concerns , such as increasing rates of hospice live discharges , hospice patients at home who are not visited by professional staff in the last days of life , and for - profit hospice programs that are less likely to provide discretionary or noncore hospice services than nonprofit programs.4 - 7 Dying patients are a vulnerable population and often are impoverished , frail , older , and cognitively impaired.8 As both private insurers and Medicare change the financial incentives in health care from doing “ more ” to “ less , ” there is an increased need for transparency and accountability .
While the majority of hospice programs are of high quality , there is a significant minority for which there is emerging evidence of concerns , such as increasing rates of hospice live discharges , hospice patients at home who are not visited by professional staff in the last days of life , and for - profit hospice programs that are less likely to provide discretionary or noncore hospice services than nonprofit programs.4 - 7 Dying patients are a vulnerable population and often are impoverished , frail , older , and cognitively impaired.8 As both private insurers and Medicare change the financial incentives in health care from doing “ more ” to “ less , ” there is an increased need for transparency and accountability .
While the majority of hospice programs are of high quality , there is a significant minority for which there is emerging evidence of concerns , such as increasing rates of hospice live discharges , hospice patients at home who are not visited by professional staff in the last days of life , and for - profit hospice programs that are less likely to provide discretionary or noncore hospice services than nonprofit programs.4 - 7 Dying patients are a vulnerable population and often are impoverished , frail , older , and cognitively impaired.8 As both private insurers and Medicare change the financial incentives in health care from doing “ more ” to “ less , ” there is an increased need for transparency and accountability .
An important threat to the validity of this cross - sectional , retrospective study was that the unobserved difference in preferences for aggressive care may explain the observed cost savings . Rightfully , the authors acknowledge this and other limitations , such as restriction of the study population to patients with cancer , exclusion of Medicare beneficiaries with managed care and non - Medicare patients , and reliance only on claims - based information for risk adjustments .
An important threat to the validity of this cross - sectional , retrospective study was that the unobserved difference in preferences for aggressive care may explain the observed cost savings . Rightfully , the authors acknowledge this and other limitations , such as restriction of the study population to patients with cancer , exclusion of Medicare beneficiaries with managed care and non - Medicare patients , and reliance only on claims - based information for risk adjustments .
An important threat to the validity of this cross - sectional , retrospective study was that the unobserved difference in preferences for aggressive care may explain the observed cost savings . Rightfully , the authors acknowledge this and other limitations , such as restriction of the study population to patients with cancer , exclusion of Medicare beneficiaries with managed care and non - Medicare patients , and reliance only on claims - based information for risk adjustments .
An important threat to the validity of this cross - sectional , retrospective study was that the unobserved difference in preferences for aggressive care may explain the observed cost savings . Rightfully , the authors acknowledge this and other limitations , such as restriction of the study population to patients with cancer , exclusion of Medicare beneficiaries with managed care and non - Medicare patients , and reliance only on claims - based information for risk adjustments .
Patients who received hospice care , vs matched control patients not receiving hospice , had lower rates of hospitalizations ( 42% vs 65% ) , intensive care admissions ( 15% vs 36% ) , and invasive procedures ( 27% vs 51% ) , as well as lower total expenditures over the last year of life ( $ 62 819 vs $ 71 517 ) , a relative savings of nearly $ 9000 per patient who chose hospice .
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