Haider Warraich, MD, a fellow in cardiology at Duke University Medical Center, argues in a STAT op-ed that hospitals should be ranked on how well they manage patients' deaths.
Though many people want to die at home, most Americans die in healthcare facilities. Only one-third of U.S. residents with heart disease die at home, according to research Dr. Warraich recently co-authored in JACC.
Physicians and patients may not be on the same page as far as death and dying are concerned, Susan Block, MD, professor of psychiatry and medicine at Harvard Medical School and co-director of the school's Center for Palliative Care, told Dr. Warraich.
"Patients aren't thinking about things like whether they should get CPR or not," Dr. Block said. "They are thinking of personal values."
Dr. Warraich imagines the following criteria could be incorporated into a death-ranking:
- Percentage of patients who receive heroic measures like CPR
- Appropriate use of hospice and palliative care
- Likelihood of family recommending the hospital for end-of-life care
- Whether patients' location of death was concordant with the place in which they had wanted to die
Instead of a separate death ranking, end-of-life care aspects could also be incorporated into existing rankings.
"Hospitals have few incentives to deliver high quality care to patients when they are dying and face little scrutiny," Dr. Warraich wrote. "That has to change."
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