|Visits To Primary Care Physicians May Decrease Hospital Stays At End-of-Life
Medicare beneficiaries can reduce their hospital use at
the end-of-life with visits to primary care physicians, according to a
study from Boston University School of Medicine (BUSM).
Researchers found that patients with more primary care
visits in the year before their death resulted in less hospital
utilization than those with fewer visits.
Those who had no primary care visits, 38 percent of
Medicare beneficiaries in the study, had 15.3 days in the hospital
while patients with at least nine visits had only 13.4 days, according
Costs were also lower between patients with no visits
versus those with nine or more. Care for those with no visits averaged
approximately $24,400 while more visits cost $23,400, a difference of
$1,000 per patient, according to the study.
The study also found that while 44 percent of those
without primary care visits near the end of life died in the hospital,
only 40 percent of patients with more visits did the same.
"Primary care visits in the preceding year of life are
associated with less, and less costly, end-of-life hospital
utilization," said Dr. Andrea Kronman, senior author and instructor of
medicine at BUSM.
"Decreasing just one hospital day for each Medicare
beneficiary at the end of life could have savedmillions of dollars,"
Researchers evaluated 78,356 Medicare beneficiaries over the age of 66 for the study.
Current end-of-life treatments cost Medicare approximately 30 percent of its total spending.
Problems have arisen including late referrals to
hospice, overtreatment, inefficient pain management and in-hospital
deaths in the present system, according to researchers.
"More care at the end of life by a primary care
physician could enhance quality and reduce costs," said Kronman, "since
the provider may have more opportunities to prevent medical
complications, discuss patient preferences and coordinate home
Address: Boston University School of Medicine, 715 Albany St., Boston, MA 02118; (617) 638-5300, www.bumc.bu.edu.