Feeding Tubes at End of Life? Study Uses Medicare-Data to Evaluate Care for Older Patients

A John A. Hartford Foundation-sponsored study released this month uses Medicare data to examine health care for older Americans, with a self-described “emphasis on the patient’s perspective.” Both the methodology and the conclusions are intriguing.  The researchers report:

For the first time, we measure the intensity of care in terms of how many days per year the average Medicare beneficiary is in contact with the health care system. We can see that beneficiaries in some regions see twice as many unique clinicians for ambulatory care than in others. We also can see in which regions beneficiaries are more likely than not to have a primary care physician as their predominant provider of care.

 

We also examine the adoption of new evidence-based practices to show that, while some regions showed substantial progress, others still fall short. For example, in some regions, fewer seniors are being prescribed inappropriate high-risk medications, and in others, thirty-day readmission rates are falling. Yet screening tests for prostate cancer and breast cancer among beneficiaries 75 and older remain unnecessarily high, and the data in this report suggest that we are still waiting too long to refer patients to hospice care.

On the one hand, the report demonstrates wide regional variation in the percentage of patients enrolled in “hospice” during the last three days of an individual’s life.  The researchers conclude: “Referrals to hospice care that are done too late … adversely affect the quality of care, the reported experiences of patients and families, and their satisfaction with the health care system.” 

On the other hand, the report cites “clinical evidence” that shows that “feeding tube placement” in patients with advanced dementia “does not prolong life or improve outcomes, and in fact leads to further complications and adverse effects such as the increased use of restraints.”  Nonetheless, the report shows that in some regions of the country, 12% to 14% of patients with dementia may be on feeding tubes, pointing to locations such as southern California, Lake Charles, Louisiana, and Dearborn, Michigan.

For the full report, see the Dartmouth Atlas project report, “Our Patients, Ourselves: Health Care for an Aging Population.” 

Further, for an region-specific analysis of the report findings, see iNewsource’s “Care for San Diego’s Dying Patients Needs to Improve, Study Finds.”