McGowan Institute for Regenerative Medicine
faculty members Mark Roberts, MD, chair of health policy and management at University of Pittsburgh’s Graduate School of Public Health, and Derek Angus, MD, professor in critical care medicine as well as health policy and management at the University of Pittsburgh and vice chair for research in the Department of Critical Care, are co-authors on a study, funded by the National Institutes of Health’s National Institute on Aging, which showed that patients admitted to hospitals with higher-intensity end-of-life care live longer than those admitted to hospitals with low-intensity approaches. Higher-intensity care refers to greater use of life-sustaining measures such as ICU admission, intubation or mechanical ventilation, kidney dialysis, and feeding tubes. The study examined admission records of more than one million patients 65 and older in Pennsylvania hospitals between 2001 and 2005.
The team of researchers found a survival benefit in hospitals with more intensive treatment styles, but this benefit lessened with time. After 30 days, patients treated at high-intensity hospitals had a 7 percent risk of dying compared to 9 percent at low-intensity hospitals. By 6 months post-admission, the risk of dying increased to 18 percent compared to 19.5 percent respectively. Risk of dying was the same for higher-intensity hospitals as average-intensity hospitals 6 months after admission.
Unlike previous studies that assessed records of people who died having received life-sustaining measures, the team looked at all seniors admitted to hospitals to determine the impact of intensity style on survival.
“Looking solely at people who received life support and died will not give you a true indication of how these measures impact survival,” said team leader Amber E. Barnato, MD, MPH, associate professor of medicine, clinical and translational science and health policy, University of Pittsburgh. “That’s akin to being a Monday morning quarterback. Instead, we looked at a hospital’s approach to people who were sick enough to die.”
The study did not address questions about the cost effectiveness of greater end-of-life treatment intensity or the quality of life experienced by the patients who lived longer because they went to a more intensive hospital.
Illustration: Microsoft clipart.
University of Pittsburgh Schools of the Health Sciences Media Relations (02/11/10)
Medical News Today (02/13/10)
Bio: Dr. Mark Roberts
Bio: Dr. Derek Angus
Abstract (Medical Care; February 2010 - Volume 48 - Issue 2 - pp 125-132)