End-of-life care in the intensive care unit: Can we simultaneously increase quality and reduce costs?

American Journal of Respiratory and Critical Care Medicine

Volumn 186, Issue 7, 2012, Pages 587-592

  Curtis, J Randall ^a   Engelberg, Ruth A ^a   Bensink, Mark E ^b   Ramsey, Scott D ^b  

^a UNIVERSITY OF WASHINGTON   (United States)

^b Fred Hutchinson Cancer Research Center   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

CLINICAL PRACTICE; COST CONTROL; CRITICAL ILLNESS; DEATH; DECISION MAKING; HEALTH CARE COST; HEALTH CARE QUALITY; HUMAN; INTENSIVE CARE UNIT; PATIENT CARE; PRIORITY JOURNAL; REVIEW; TERMINAL CARE; UNITED STATES;

COST SAVINGS; HEALTH CARE COSTS; HUMANS; INTENSIVE CARE; PALLIATIVE CARE; QUALITY OF HEALTH CARE; TERMINAL CARE;

EID: 84867136395     PISSN: 1073449X     EISSN: 15354970     Source Type: Journal    
DOI: 10.1164/rccm.201206-1020CP     Document Type: Review

References (68)

1. Halpern NA, Pastores SM, Greenstein RJ. Critical care medicine in the United States 1985-2000: an analysis of bed numbers, use, and costs. Crit Care Med 2004;32:1254-1259. (Pubitemid 38738575)
2. Milbrandt EB, Kersten A, Rahim MT, Dremsizov TT, Clermont G, Cooper LM, Angus DC, Linde-Zwirble WT. Growth of intensive care unit resource use and its estimated cost in Medicare. Crit Care Med 2008;36:2504-2510.
3. Angus DC, Barnato AE, Linde-Zwirble WT, Weissfeld LA, Watson RS, Rickert T, Rubenfeld GD; Robert Wood Johnson Foundation ICU End-of-Life Peer Group. Use of intensive care at the end of life in the United States: an epidemiologic study. Crit Care Med 2004;32:638-643. (Pubitemid 38340056)
4. Riley GF, Lubitz JD. Long-term trends in Medicare payments in the last year of life. Health Serv Res 2010;45:565-576.
5. Seshamani M, Gray AM. A longitudinal study of the effects of age and time to death on hospital costs. J Health Econ 2004;23:217-235. (Pubitemid 38333024)
6. The Dartmouth Atlas of Healthcare; 2011 [accessed 2012 Feb 15]. Available from: www.dartmouthatlas.org
7. NIH State-of-the-Science Conference on Improving End-of-life Care; 2004 [accessed 2012 Feb 15]. Available from http://consensus.nih.gov/2004/ 2004EndOfLifeCareSOS024html.htm
8. Lorenz KA, Lynn J, Dy SM, Shugarman LR, Wilkinson A, Mularski RA, Morton SC, Hughes RG, Hilton LK, Maglione M, et al. Evidence for improving palliative care at the end of life: a systematic review. Ann Intern Med 2008;148:147-159. (Pubitemid 351651557)
9. Curtis JR, Engelberg RA, Nielsen EL, Au DH, Patrick DL. Patient-physician communication about end-of-life care for patients with severe COPD. Eur Respir J 2004;24:200-205. (Pubitemid 39139785)
10. McNeely PD, Hebert PC, Dales RE, O'Connor AM, Wells G, McKim D, Sullivan KE. Deciding about mechanical ventilation in end-stage chronic obstructive pulmonary disease: how respirologists perceive their role. CMAJ 1997;156:177-183. (Pubitemid 27065009)
11. Piers RD, Azoulay E, Ricou B, Dekeyser Ganz F, Decruyenaere J, Max A, Michalsen A, Maia PA, Owczuk R, Rubulotta F, et al. Perceptions of appropriateness of care among European and Israeli intensive care unit nurses and physicians. JAMA 2011;306:2694-2703.
12. Cher DJ, Lenert LA. The effect of reimbursement method on the rate of potentially ineffective care in medicare patients. JAMA 1997;278:1001-1007. (Pubitemid 27430197)
13. Luce JM, Rubenfeld GD. Can health care costs be reduced by limiting intensive care at the end of life? Am J Respir Crit Care Med 2002;165:750-754. (Pubitemid 34229641)
14. The SUPPORT Principal Investigators. A controlled trial to improve care for seriously ill hospitalized patients: the study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). JAMA 1995;274:1591-1598.
15. Schneiderman LJ, Kronick R, Kaplan RM, Anderson JP, Langer RD. Effects of offering advance directives on medical treatment and costs. Ann Intern Med 1992;117:599-606.
16. Cooke CR. The siren song of simple tools that predict mortality. Respir Care 2011;56:533-535.
17. Sudore RL, Fried TR. Redefining the "planning" in advance care planning: preparing for end-of-life decision making. Ann Intern Med 2010;153:256-261.
18. Detering KM, Hancock AD, Reade MC, Silvester W. The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ 2010;340:c1345.
19. Hammes BJ, Rooney BL, Gundrum JD. A comparative, retrospective, observational study of the prevalence, availability, and specificity of advance care plans in a county that implemented an advance care planning microsystem. J Am Geriatr Soc 2010;58:1249-1255.
20. Quill TE, Holloway R. Time-limited trials near the end of life. JAMA 2011;306:1483-1484.
21. Lautrette A, Darmon M, Megarbane B, Joly LM, Chevret S, Adrie C, Barnoud D, Bleichner G, Bruel C, Choukroun G, et al. A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med 2007;356:469-478. (Pubitemid 46193074)
22. Curtis JR, Burt RA. Why are critical care clinicians so powerfully distressed by family demands for futile care? J Crit Care 2003;18:22-24. (Pubitemid 36356514)
23. Teno JM, Murphy D, Lynn J, Tosteson A, Desbiens N, Connors AF Jr, Hamel MB, Wu A, Phillips R, Wenger N, et al. Prognosis-based futility guidelines: does anyone win? SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. J Am Geriatr Soc 1994;42:1202-1207.
24. Fine RL. Point: the Texas Advance Directives Act effectively and ethically resolves disputes about medical futility. Chest 2009;136:963-967.
25. Truog RD. Counterpoint: the Texas Advance Directives Act is ethically flawed: medical futility disputes must be resolved by a fair process. Chest 2009;136:968-971, discussion 71-73.
26. Fried TR, Bradley EH, Towle VR, Allore H. Understanding the treatment preferences of seriously ill patients. N Engl J Med 2002;346:1061-1066. (Pubitemid 34984621)
27. Cassel CK, Guest JA. Choosing wisely: helping physicians and patients make smart decisions about their care. JAMA 2012;307:1801-1802.
28. Cooke CR. Economics of mechanical ventilation and respiratory failure. Crit Care Clin 2012;28:39-55. (vi.).
29. Wunsch H, Gershengorn H, Scales DC. Economics of ICU organization and management. Crit Care Clin 2012;28:25-37, v.
30. Drummond M, Sculpher M, Torrance G, O'Brien B, Stoddart G. Methods for the economic evaluation of health care programmes. 3rd ed. Oxford: Oxford University Press; 2005.
31. Penner S. Introduction to health care economics and financial management: fundamental concepts with practical application. Baltimore, MD: Lippincott, Williams & Wilkins; 2003.
32. Rauh S. The fixed-cost dilemma: what counts when counting costreduction efforts? Healthc Financ Manage 2010;64:60-63.
33. Rauh SS, Wadsworth EB, Weeks WB, Weinstein JN. The savings illusion-why clinical quality improvement fails to deliver bottom-line results. N Engl J Med 2011;365:e48.
34. Fuchs VR, Milstein A. The $640 billion question: why does cost-effective care diffuse so slowly? N Engl J Med 2011;364:1985-1987.
35. Roberts RR, Frutos PW, Ciavarella GG, Gussow LM, Mensah EK, Kampe LM, Straus HE, Joseph G, Rydman RJ. Distribution of variable vs fixed costs of hospital care. JAMA 1999;281:644-649. (Pubitemid 29098066)
36. Kelley MA, Angus D, Chalfin DB, Crandall ED, Ingbar D, Johanson W, Medina J, Sessler CN, Vender JS. The critical care crisis in the United States: a report from the profession. Chest 2004;125:1514-1517. (Pubitemid 38501371)
37. Angus DC, Kelley MA, Schmitz RJ, White A, Popovich J Jr. Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: can we meet the requirements of an aging population? JAMA 2000;284:2762-2770.
38. Danis M, Southerland LI, Garrett JM, Smith JL, Hielema F, Pickard CG, Egner DM, Patrick DL. A prospective study of advance directives for life-sustaining care. N Engl J Med 1991;324:882-888.
39. Wright AA, Zhang B, Ray A, Mack JW, Trice E, Balboni T, Mitchell SL, Jackson VA, Block SD, Maciejewski PK, et al. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA 2008;300:1665-1673.
40. Zhang B, Wright AA, Huskamp HA, Nilsson ME, Maciejewski ML, Earle CC, Block SD, Maciejewski PK, Prigerson HG. Health care costs in the last week of life: associations with end-of-life conversations. Arch Intern Med 2009;169:480-488.
41. Fried TR, Bradley EH, O'Leary J. Prognosis communication in serious illness: perceptions of older patients, caregivers, and clinicians. J Am Geriatr Soc 2003;51:1398-1403. (Pubitemid 37259868)
42. Christakis NA, Lamont EB. Extent and determinants of error in doctors' prognoses in terminally ill patients: prospective cohort study. BMJ 2000;320:469-472. (Pubitemid 30173113)
43. Tulsky JA, Fischer GS, Rose MR, Arnold RM. Opening the black box: how do physicians communicate about advance directives? Ann Intern Med 1998;129:441-449. (Pubitemid 28428079)
44. White DB, Braddock CH III, Bereknyei S, Curtis JR. Toward shared decision making at the end of life in intensive care units: opportunities for improvement. Arch Intern Med 2007;167:461-467. (Pubitemid 46425658)
45. Rocker GM, Heyland DK, Cook DJ, Dodek PM, Kutsogiannis DJ, O'Callaghan CJ. Most critically ill patients are perceived to die in comfort during withdrawal of life support: a Canadian multicentre study. Can J Anaesth 2004;51:623-630. (Pubitemid 38867929)
46. Tilden VP, Tolle SW, Garland MJ, Nelson CA. Decisions about life-sustaining treatment: impact of physicians' behaviors on the family. Arch Intern Med 1995;155:633-638.
47. Dickson RP, Engelberg RA, Downey L, Back AL, Ford DW, Curtis JR. Internal medicine trainee self-assessments of end-of-life communication skills do not predict assessments of patients, families, or clinician-evaluators. J Palliat Med 2012;15:418-426.
48. Teno JM, Gruneir A, Schwartz Z, Nanda A, Wetle T. Association between advance directives and quality of end-of-life care: a national study. J Am Geriatr Soc 2007;55:189-194. (Pubitemid 46184393)
49. Silveira MJ, Kim SY, Langa KM. Advance directives and outcomes of surrogate decision making before death. N Engl J Med 2010;362:1211-1218.
50. Living Well at the End of Life. A National Conversation; 2011 [accessed July 10, 2012]. Available from http://syndication.nationaljournal.com/ communications/NationalJournalRegenceToplines.pdf
51. Curtis JR. Reimbursement for advance care planning: why should intensivists care? Am J Respir Crit Care Med 2011;184:387-388.
52. Nelson JE, Bassett R, Boss RD, Brasel KJ, Campbell ML, Cortez TB, Curtis JR, Lustbader DR, Mulkerin C, Puntillo KA, et al. Models for structuring a clinical initiative to enhance palliative care in the intensive care unit: a report from the IPAL-ICU Project (Improving Palliative Care in the ICU). Crit Care Med 2010;38:1765-1772.
53. Campbell ML, Guzman JA. Impact of a proactive approach to improve end-of-life care in a medical ICU. Chest 2003;123:266-271. (Pubitemid 36126739)
54. Norton SA, Hogan LA, Holloway RG, Temkin-Greener H, Buckley MJ, Quill TE. Proactive palliative care in the medical intensive care unit: effects on length of stay for selected high-risk patients. Crit Care Med 2007;35:1530-1535. (Pubitemid 46809317)
55. Schneiderman LJ, Gilmer T, Teetzel HD. Impact of ethics consultations in the intensive care setting: a randomized, controlled trial. Crit Care Med 2000;28:3920-3924. (Pubitemid 32044493)
56. Schneiderman LJ, Gilmer T, Teetzel HD, Dugan DO, Blustein J, Cranford R, Briggs KB, Komatsu GI, Goodman-Crews P, Cohn F, et al. Effect of ethics consultations on nonbeneficial life-sustaining treatments in the intensive care setting: a randomized controlled trial. JAMA 2003;290:1166-1172. (Pubitemid 37430421)
57. Morrison RS, Penrod JD, Cassel JB, Caust-Ellenbogen M, Litke A, Spragens L, Meier DE. Cost savings associated with US hospital palliative care consultation programs. Arch Intern Med 2008;168:1783-1790.
58. Morrison RS, Dietrich J, Ladwig S, Quill T, Sacco J, Tangeman J, Meier DE. Palliative care consultation teams cut hospital costs for Medicaid beneficiaries. Health Aff (Millwood) 2011;30:454-463.
59. Hanson LC, Usher B, Spragens L, Bernard S. Clinical and economic impact of palliative care consultation. J Pain Symptom Manage 2008;35:340-346.
60. Cassel JB, Webb-Wright J, Holmes J, Lyckholm L, Smith TJ. Clinical and financial impact of a palliative care program at a small rural hospital. J Palliat Med 2010;13:1339-1343.
61. Smith TJ, Cassel JB. Cost and non-clinical outcomes of palliative care. J Pain Symptom Manage 2009;38:32-44.
62. Lilly CM, De Meo DL, Sonna LA, Haley KJ, Masaro AF, Wallace RF, Cody S. An intensive communication intervention for the critically ill. Am J Med 2000;109:469-475.
63. Daly BJ, Douglas SL, O'Toole E, Gordon NH, Hejal R, Peerless J, Rowbottom J, Garland A, Lilly C, Wiencek C, et al. Effectiveness trial of an intensive communication structure for families of long-stay ICU patients. Chest 2010;138:1340-1348.
64. Curtis JR, Treece PD, Nielsen EL, Downey L, Shannon SE, Braungardt T, Owens D, Steinberg KP, Engelberg RA. Integrating palliative and critical care: evaluation of a quality-improvement intervention. Am J Respir Crit Care Med 2008;178:269-275.
65. Curtis JR, Nielsen EL, Treece PD, Downey L, Dotolo D, Shannon SE, Back AL, Rubenfeld GD, Engelberg RA. Effect of a quality-improvement intervention on end-of-life care in the intensive care unit: a randomized trial. Am J Respir Crit Care Med 2011;183:348-355.
66. Scheunemann LP, McDevitt M, Carson SS, Hanson LC. Randomized, controlled trials of interventions to improve communication in intensive care: a systematic review. Chest 2011;139:543-554.
67. Angus DC, Shorr AF, White A, Dremsizov TT, Schmitz RJ, Kelley MA. Critical care delivery in the United States: distribution of services and compliance with Leapfrog recommendations. Crit Care Med 2006;34:1016-1024.
68. Kahn JM, Rubenfeld GD, Rohrbach J, Fuchs BD. Cost savings attributable to reductions in intensive care unit length of stay for mechanically ventilated patients. Med Care 2008;46:1226-1233.