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Too Few Americans Pass Last Days in Hospice Care: CDC

Report highlights need for alternative care at end of life, expert says

By Steven Reinberg
HealthDay Reporter

WEDNESDAY, March 27 (HealthDay News) -- Many people are still dying in hospitals, despite the fact that there has been a decrease in the number of patients who spend their final days in a setting that most would rather avoid, a new government report shows.

While the number of people admitted to U.S. hospitals increased 11 percent between 2000 and 2010, going from 31.7 million to 35.1 million, the number of people who died in hospitals dropped 8 percent, from 776,000 to 715,000, according to the U.S. Centers for Disease Control and Prevention.

The drop in hospital deaths occurred largely among women, the researchers found.

"That could just be that there were more older women who were able to be placed in alternative settings, because women live longer. That's just a hypothesis," said report author Margaret Jean Hall, from the CDC's National Center for Health Statistics (NCHS). The report was released Wednesday and published in the March NCHS Data Brief.

Overall, the in-hospital death rate is 20 percent lower for people who die from their diagnosed disease, Hall said. For some conditions, however, the decrease is even greater. For example, the in-hospital death rate is down 65 percent for kidney disease, 46 percent for cancer and 27 percent for stroke, Hall noted.

"Almost all of the major reasons people [who are hospitalized die] have gone down," Hall added. "This doesn't mean they are going home or [being] cured, but they aren't dying in the hospital in as large an extent as they were in earlier years."

Because people generally prefer to die at home and not in the hospital, "this is a good sign," Hall pointed out. "But we don't know where they go right after leaving the hospital."

Many patients could be going to nursing homes or to long-term care facilities, Hall suggested. "But these alternatives are less intense and maybe closer to a setting that would be preferable to the high-tech hospital," she explained.

The one area where the in-hospital death rate has increased involved cases of life-threatening blood infections, jumping 17 percent from 2000 to 2010. Whether these infections developed in the hospital isn't known because the report only deals with the conditions patients were diagnosed with when they were admitted to the hospital, Hall said.

Highlights of the report include:

  • About 25 percent of those who die in hospitals are aged 85 and older.
  • People who die in hospitals are there longer than other patients, an average of 7.9 days versus 4.8 days.
  • Fewer women died in U.S. hospitals in 2010 (364,000) than in 2000 (411,000).
  • In-hospital death rates among men haven't changed significantly.

One expert thinks the report is a good argument for better end-of-life care.

"I think this points out several key gaps in the health care system," said Dr. R. Sean Morrison, director of the National Palliative Care Research Center at Mount Sinai School of Medicine in New York City.

One is the need for community palliative care services, he said.

Although palliative care teams are in place at most hospitals, they are still not very accessible to people in the community, he explained. "Without community palliative care, it is very hard for seriously ill persons to receive the care they need at home," Morrison said.

In addition, while insurance covers hospital care comprehensively, the cost of the same care at home is largely borne by patients because it is not covered by insurance, he noted.

"People want to be cared for where they feel safe," Morrison said. "If there are large gaps in coverage at home, even if they would prefer to be at home, they are likely to end up in hospital."

More information

For more on end-of-life care, visit the U.S. National Library of Medicine.


SOURCES: Margaret Jean Hall, Ph.D., National Center for Health Statistics, U.S. Centers for Disease Control and Prevention; R. Sean Morrison, M.D., director, National Palliative Care Research Center, Mount Sinai School of Medicine, New York City; March 27, 2013, NCHS Data Brief, Trends in Inpatient Hospital Deaths: National Hospital Discharge Survey, 2000-2010

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