The report shows that many challenges remain to improving the care of patients with serious, life-limiting illness. For more than 20 years, the Dartmouth Atlas Project has documented glaring variations in how medical resources are distributed and used in the United States.
- Over one third of Medicare patients with poor prognosis cancer spent their last days in hospitals and intensive care units. A significant proportion recived advanced life support interventions, such as endotracheal intubation, feeding tubes, and CPR.
- Overall, 6% of patients received chemotherapy in the last two weeks of life, but in some regions this exceeded 10%.
- The use of hospice care varied markedly across regions and hospitals. In at least 50 academic medical centers, less than half of patients with poor prognosis cancer received hospice services.
- In some hospitals, referral to hospice care occurred so close to the day of death that it was unlikely to have provided much assistance or comfort to patients.
- There was a high degree of regional variation in the amount of inpatient care patients with poor prognosis cancer received. Neither established differences in racial and ethnic preferences for aggressive treatment or patient illness levels explained the degree of variation observed.