Patients admitted to hospitals with higher-intensity end-of-life (EOL) care live longer than those admitted to hospitals with low-intensity approaches according to a University of Pittsburgh study . Higher intensity care includes greater use of ICU admission, intubation or mechanical ventilation, kidney dialysis, and feeding tubes.
Amber E. Barnato, MD, MPH MS, lead author, and colleagues, set out to explore the relationship between hospital EOL treatment intensity and postadmission survival. In a retrospective study, the investigators examined admission records of more than 1 million patients age 65 and older in Pennsylvania hospitals between 2001 and 2005. Study measures were EOL treatment intensity among patients with high predicted probability of dying at admission and 30- and 180-day postadmission mortality.
The researchers found small gains in postdmission survival in hospitals with more intensive treatment styles, although this benefit lessened over time. After 30 days, patients treated at high-intensity hospitals had a 7% risk of dying compared to 9% at low-intensity hospitals. By 6-months postadmission, the risk of dying increased to 18% compared to 19.5% respectively.
The investigators did not look at the cost effectiveness of higher-intensity treatment or the quality of life of those patients who lived longer because they received such treatment. “Ongoing controversies about the utility and cost effectiveness of life-sustaining treatment for individual patients will not be solved by this study,” said Barnato, in a statement released by the university.
Source: University of Pittsburgh