High-Intensity Approach To End Of Life Results In Survival Benefit

Patients admitted to hospitals with a high-intensity approach to end-of-life care live longer than those admitted to hospitals with a low-intensity approach, according to a new study by the University of Pittsburgh, published in the journal Medical Care.

Higher-intensity care involves greater use of ICU admission, intubation, mechanical ventilation, kidney dialysis, feeding tubes and other similar life-sustaining measures.

Admission records of more than one million patients 65 and older in Pennsylvania hospitals between 2001 and 2005 were examined by lead author, Amber E. Barnato, MD, MPH, associate professor of medicine, clinical and translational science and health policy at the University of Pittsburgh and her colleagues.

The impact of intensity style on survival is what set this study apart from previous studies on people who have died having received life-sustaining measures.

After 30 days, patients at a high-intensity hospital had a 7 percent risk of dying as compared with a 9 percent risk at low-intensity hospitals, according to the research.

By six months post-admission, the risk of dying increased to 18 percent and 19.5 percent, respectively.

Risk of dying was determined to be the same, six months post-admission, for higher-intensity hospitals as compared with average-intensity hospitals.

The study did not address the cost-effectiveness or quality of life experienced through greater end-of-life treatment intensity.

"Looking solely at people who receive life support and died will not give you a true indication of how these measures impact survival," said Barnato. "That’s akin to being a Monday morning quarterback. Instead, we look at a hospital’s approach to people who were sick enough to die."

" ... our findings support the strategy of hospitals ‘moving toward the middle,’ when it comes to life-sustaining interventions," said Barnato.

For more information on the University of Pittsburgh, visit www.pitt.edu.