Medical care inconsistent with patients' treatment goals: Association with 1-year Medicare resource use and survival

Joan Teno, Elliott S. Fisher, Mary Beth Hamel, Kristen Coppola, Neal V. Dawson

Research output: Contribution to journalArticle

117 Citations (Scopus)

Abstract

OBJECTIVES: To describe how frequently seriously ill persons perceive that the care they receive is inconsistent with treatment preferences and the effect on 1-year resource utilization. SETTING: Five U.S. teaching hospitals. DESIGN: Secondary analysis of interview data. PARTICIPANTS: Seriously ill Medicare beneficiaries. MEASUREMENTS: Interviews about patients' preferred approaches to care and whether they perceived care was consistent with these preferences. Part A and B costs for up to 1 year, adjusted for cost differences across hospitals and over time and for 1-year survival. RESULTS: Forty percent of the 1,185 study patients expressed a preference for treatment to focus on extending life, whereas 60% expressed a preference for comfort care. Eighty-six percent of the patients who wanted aggressive treatment reported that care was consistent with their preferences, but only 41% of those who preferred comfort care reported that care was consistent with their preferences. More than one-third of those with a preference for comfort care (35%) reported that the medical care that they received was inconsistent with their goals; 24% were unsure of treatment goals. Those who preferred comfort care but believed that their care was inconsistent with their wishes had higher estimated mean 1-year costs than those who believed that their care was consistent with their wishes ($92,442 vs $52,098, P < .001). Even after adjusting for differences in disease severity, age, gender, race, functional status, income, and years of education, adjusted costs were 1.4 times (95% confidence interval = 1.2-1.6) higher. However, 1-year survival was lower in these patients who stated that care was consistent with their preference to focus on comfort care than for those who wished to receive comfort care and stated that care was not consistent with their preference (38% vs 55% 1-year survival, P < .001). CONCLUSION: More than one in three seriously ill persons who prefer comfort care believe that their medical care is at odds with their preference that treatment focus on palliation. Such discord was associated with higher 1-year healthcare costs and increased survival.

Original languageEnglish (US)
Pages (from-to)496-500
Number of pages5
JournalJournal of the American Geriatrics Society
Volume50
Issue number3
DOIs
StatePublished - Mar 26 2002
Externally publishedYes

Fingerprint

Medicare
Survival
Costs and Cost Analysis
Therapeutics
Interviews
Patient Comfort
Teaching Hospitals
Health Care Costs
Confidence Intervals
Education

Keywords

  • Advance directives
  • Medicare
  • Preferences
  • Resource utilization
  • Right to die
  • Terminal care

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Medical care inconsistent with patients' treatment goals : Association with 1-year Medicare resource use and survival. / Teno, Joan; Fisher, Elliott S.; Hamel, Mary Beth; Coppola, Kristen; Dawson, Neal V.

In: Journal of the American Geriatrics Society, Vol. 50, No. 3, 26.03.2002, p. 496-500.

Research output: Contribution to journalArticle

Teno, Joan ; Fisher, Elliott S. ; Hamel, Mary Beth ; Coppola, Kristen ; Dawson, Neal V. / Medical care inconsistent with patients' treatment goals : Association with 1-year Medicare resource use and survival. In: Journal of the American Geriatrics Society. 2002 ; Vol. 50, No. 3. pp. 496-500.
@article{42f1115fca964f10aeec8afbdbe03735,
title = "Medical care inconsistent with patients' treatment goals: Association with 1-year Medicare resource use and survival",
abstract = "OBJECTIVES: To describe how frequently seriously ill persons perceive that the care they receive is inconsistent with treatment preferences and the effect on 1-year resource utilization. SETTING: Five U.S. teaching hospitals. DESIGN: Secondary analysis of interview data. PARTICIPANTS: Seriously ill Medicare beneficiaries. MEASUREMENTS: Interviews about patients' preferred approaches to care and whether they perceived care was consistent with these preferences. Part A and B costs for up to 1 year, adjusted for cost differences across hospitals and over time and for 1-year survival. RESULTS: Forty percent of the 1,185 study patients expressed a preference for treatment to focus on extending life, whereas 60{\%} expressed a preference for comfort care. Eighty-six percent of the patients who wanted aggressive treatment reported that care was consistent with their preferences, but only 41{\%} of those who preferred comfort care reported that care was consistent with their preferences. More than one-third of those with a preference for comfort care (35{\%}) reported that the medical care that they received was inconsistent with their goals; 24{\%} were unsure of treatment goals. Those who preferred comfort care but believed that their care was inconsistent with their wishes had higher estimated mean 1-year costs than those who believed that their care was consistent with their wishes ($92,442 vs $52,098, P < .001). Even after adjusting for differences in disease severity, age, gender, race, functional status, income, and years of education, adjusted costs were 1.4 times (95{\%} confidence interval = 1.2-1.6) higher. However, 1-year survival was lower in these patients who stated that care was consistent with their preference to focus on comfort care than for those who wished to receive comfort care and stated that care was not consistent with their preference (38{\%} vs 55{\%} 1-year survival, P < .001). CONCLUSION: More than one in three seriously ill persons who prefer comfort care believe that their medical care is at odds with their preference that treatment focus on palliation. Such discord was associated with higher 1-year healthcare costs and increased survival.",
keywords = "Advance directives, Medicare, Preferences, Resource utilization, Right to die, Terminal care",
author = "Joan Teno and Fisher, {Elliott S.} and Hamel, {Mary Beth} and Kristen Coppola and Dawson, {Neal V.}",
year = "2002",
month = "3",
day = "26",
doi = "10.1046/j.1532-5415.2002.50116.x",
language = "English (US)",
volume = "50",
pages = "496--500",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",
number = "3",

}

TY - JOUR

T1 - Medical care inconsistent with patients' treatment goals

T2 - Association with 1-year Medicare resource use and survival

AU - Teno, Joan

AU - Fisher, Elliott S.

AU - Hamel, Mary Beth

AU - Coppola, Kristen

AU - Dawson, Neal V.

PY - 2002/3/26

Y1 - 2002/3/26

N2 - OBJECTIVES: To describe how frequently seriously ill persons perceive that the care they receive is inconsistent with treatment preferences and the effect on 1-year resource utilization. SETTING: Five U.S. teaching hospitals. DESIGN: Secondary analysis of interview data. PARTICIPANTS: Seriously ill Medicare beneficiaries. MEASUREMENTS: Interviews about patients' preferred approaches to care and whether they perceived care was consistent with these preferences. Part A and B costs for up to 1 year, adjusted for cost differences across hospitals and over time and for 1-year survival. RESULTS: Forty percent of the 1,185 study patients expressed a preference for treatment to focus on extending life, whereas 60% expressed a preference for comfort care. Eighty-six percent of the patients who wanted aggressive treatment reported that care was consistent with their preferences, but only 41% of those who preferred comfort care reported that care was consistent with their preferences. More than one-third of those with a preference for comfort care (35%) reported that the medical care that they received was inconsistent with their goals; 24% were unsure of treatment goals. Those who preferred comfort care but believed that their care was inconsistent with their wishes had higher estimated mean 1-year costs than those who believed that their care was consistent with their wishes ($92,442 vs $52,098, P < .001). Even after adjusting for differences in disease severity, age, gender, race, functional status, income, and years of education, adjusted costs were 1.4 times (95% confidence interval = 1.2-1.6) higher. However, 1-year survival was lower in these patients who stated that care was consistent with their preference to focus on comfort care than for those who wished to receive comfort care and stated that care was not consistent with their preference (38% vs 55% 1-year survival, P < .001). CONCLUSION: More than one in three seriously ill persons who prefer comfort care believe that their medical care is at odds with their preference that treatment focus on palliation. Such discord was associated with higher 1-year healthcare costs and increased survival.

AB - OBJECTIVES: To describe how frequently seriously ill persons perceive that the care they receive is inconsistent with treatment preferences and the effect on 1-year resource utilization. SETTING: Five U.S. teaching hospitals. DESIGN: Secondary analysis of interview data. PARTICIPANTS: Seriously ill Medicare beneficiaries. MEASUREMENTS: Interviews about patients' preferred approaches to care and whether they perceived care was consistent with these preferences. Part A and B costs for up to 1 year, adjusted for cost differences across hospitals and over time and for 1-year survival. RESULTS: Forty percent of the 1,185 study patients expressed a preference for treatment to focus on extending life, whereas 60% expressed a preference for comfort care. Eighty-six percent of the patients who wanted aggressive treatment reported that care was consistent with their preferences, but only 41% of those who preferred comfort care reported that care was consistent with their preferences. More than one-third of those with a preference for comfort care (35%) reported that the medical care that they received was inconsistent with their goals; 24% were unsure of treatment goals. Those who preferred comfort care but believed that their care was inconsistent with their wishes had higher estimated mean 1-year costs than those who believed that their care was consistent with their wishes ($92,442 vs $52,098, P < .001). Even after adjusting for differences in disease severity, age, gender, race, functional status, income, and years of education, adjusted costs were 1.4 times (95% confidence interval = 1.2-1.6) higher. However, 1-year survival was lower in these patients who stated that care was consistent with their preference to focus on comfort care than for those who wished to receive comfort care and stated that care was not consistent with their preference (38% vs 55% 1-year survival, P < .001). CONCLUSION: More than one in three seriously ill persons who prefer comfort care believe that their medical care is at odds with their preference that treatment focus on palliation. Such discord was associated with higher 1-year healthcare costs and increased survival.

KW - Advance directives

KW - Medicare

KW - Preferences

KW - Resource utilization

KW - Right to die

KW - Terminal care

UR - http://www.scopus.com/inward/record.url?scp=0036119133&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036119133&partnerID=8YFLogxK

U2 - 10.1046/j.1532-5415.2002.50116.x

DO - 10.1046/j.1532-5415.2002.50116.x

M3 - Article

C2 - 11943046

AN - SCOPUS:0036119133

VL - 50

SP - 496

EP - 500

JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

SN - 0002-8614

IS - 3

ER -