The quality of end-of-life care is influenced by geographic location, argue Andrew MacPherson, principal at Healthsperie, and Ravi B. Parikh, hematology/oncology fellow at Penn Medicine, in a Washington Post analysis.
The authors used data from the Dartmouth Atlas, an information and analytics source that organizes Medicare data by indicators linked to how patients use medical resources. They then ranked geographic areas based on factors contributing to end-of-life care quality, such as the number of patient deaths in the hospital and the number of physicians a patient sees in his or her last year of life.
The analysis showed race and other demographics influence end-of-life care in a given area. A systematic review of over 20 studies showed African American and Hispanic individuals utilize advance-care planning and hospice far less than their white counterparts.
However, the authors noted race and demographics do not provide all the answers for variation in the quality of end-of-life care. For example, the study found Sarasota and St. Petersburg, Fla., which are only 45 miles apart and have similar ethnic demographics, score differently on several key quality metrics at the end of life.
Factors that contribute to these findings may include the low percentage of patients who utilize hospice care, the authors noted. Despite a Medicare benefit that allows patients to stay in hospice care for up to six months, many patients enroll fewer than 20 days before death, according to the National Hospice and Palliative Care Organization.
Although Congress and health insurers have recently addressed end-of-life care quality issues, study authors note that the most important contributor to improving palliative care may be a shift in culture.
"We will not improve the death experience until we demand that our public- and private-sector leaders act and that our local health professionals encourage person-centered end-of-life care," the authors wrote.