April 2002
Dear Readers: Here's the Article for this Month:
Name of article:
MEDICAL CARE INCONSISTENT WITH PATIENTS TREATMENT GOALS: ASSOCIATION WITH 1-YEAR MEDICARE RESOURCE USE AND SURVIVAL
Author(s): Teno JM, Fisher ES, Hamel MB, Coppola K, Dawson NV
Reference: Journal of the American Geriatrics Society 2002; 50: 496-500
Abstract: A prospective cohort study was carried out on 1.275 Medicare beneficiary patients seriously ill in five U.S. teaching hospitals. The aim of the study was to evaluate how frequently medical care is perceived by these patients to be inconsistent with their preferences and the effect of discord on 1-year resource utilization and patient survival.
During the 2nd week of hospitalization data were collected from interviews with the patients (N° 633) or surrogate decision-makers (N° 532) regarding patients’ preferences for treatment approaches i.e. extending the patient’s life or the patient’s comfort, and their perceptions of what the actual treatment goals were.
The analysis used data from the intervention phase of the Study to Understand Prognosis and Preferences for Outcomes and Risks of Treatment (SUPPORT) previously published and the cases from SUPPORT were matched with Medicare claim files. For the analysis, the authors included only patients with complete information on their preferred treatment approach and complete Medicare Part A and Part B claims data for up to 1 year after study admission.
1.185 patients interviewed were considered (mean age 71.5 years; 59% male). The majority (60%) preferred that treatments focus on comfort, even if it shortened their lives, but only 41% of them reported that medical care was consistent with their preference. Medical care was inconsistent with their treatment goals (35% of patients) whereas 24% of patients were not aware of the current goals of the treatment approach.
Forty percent of the patients expressed a preference for treatment to focus on extending life and 86% of them reported that care was consistent with their preferences.
Medical costs and ICU length of stay were higher for those who preferred that their medical care focus on comfort and believed that current treatment was contrary to that preference than those who believed that their care was consistent with their wishes ($92,442 vs $ 52,098 p<.001).
Fifty-five per cent of the patients who reported that they were receiving aggressive care instead of their preferred approach of focusing on palliation were alive after 1 year with respect to the 38% of the other group of patients (p<.001).
Why I chose this Article:
This study shows the necessity of listening to the patients, improving communication and adequately informing them regarding their illness and possible therapies.
Regards,
Carla Ripamonti, MD
Member of the Board of Directors, IAHPC
