New Brigham and Women’s Study Examines End of Life Care

Patients who chose hospice were five times less likely to die in hospitals and nursing homes.

According to Brigham and Women’s Hospital (BWH), cancer patients are choosing hospice care today more than ever before. But, hospital reps say that the intensity of care outside of the hospice setting is increasing, and the length of hospice stay is decreasing.

That’s why researchers at BWH examined how hospice affects health care and the costs involved with end of life care. The researchers found—through a sample of elderly Medicare patients with advanced cancer—that hospice care was associated with “significantly lower rates of both health care utilization and total costs during the last year of life.” The bottom line: Patients who chose hospice were five times less likely to die in hospitals and nursing homes.

The findings of this study were published in November in the Journal of the American Medical Association.

“Our study shows very clearly that hospice matters. Hospice and non-hospice patients had very similar patterns of health care utilization, right up until the week of hospice enrollment—then the care started to look very different,” says Ziad Obermeyer, MD, an associate physician in BWH’s Department of Emergency Medicine and assistant professor of emergency medicine and health care policy at Harvard Medical School, in a statement. “Patients who didn’t enroll in hospice ended up with far more aggressive care in their last year of life—most of it related to acute complications like infections and organ failure, and not directly related to their cancer diagnosis.”

According to BWH, the study examined costs and health care utilization and costs:

…in a nationally-representative sample of 18,165 patients with poor-prognosis cancers (e.g., brain, pancreatic and metastatic malignancies) who enrolled in hospice before death, and compared them to 18,165 similar patients who died without hospice care. Overall, non-hospice patients had significantly more health care utilization—hospitalizations, intensive care, and invasive procedures—largely for acute conditions not directly related to cancer, and 74 percent of non-hospice patients died in hospitals and nursing facilities. Only 14 percent of patients who enrolled in hospice care died in a hospital or nursing facility. The costs of care for hospice and non-hospice patients were not significantly different before hospice care began, but diverged sharply thereafter, contributing to a statistically-significant difference in total costs of $8,697 over the last year of life ($71,517 for non-hospice and $62,819 for hospice).

“These findings highlight the importance of honest discussions between doctors and patients about our patients’ goals of their care at the end of life, relating to treatment decisions and quality of life,” Obermeyer said in a statement. “This is of particular importance now, in light of the ongoing policy discussions around reimbursing providers for advance care planning.”