The Dartmouth Atlas Applied to Kaiser Permanente: Analysis of Variation in Care at the End of Life

The Dartmouth Atlas Applied to Kaiser Permanente: Analysis of Variation in Care at the End of Life

 

Matt Stiefel, MPA; Paul Feigenbaum, MD; Elliott S Fisher, MD, MPH

Winter 2008 - Volume 12 Number 1

https://doi.org/10.7812/TPP/07-120

 

Abstract

The Dartmouth Atlas method for examination of variation in care at the end of life was replicated by Kaiser Permanente (KP). Variation within KP was analyzed and compared with corresponding Dartmouth Atlas Hospital Referral Regions. Although KP inpatient care use rates were 25% to 30% lower and hospice use rates were higher than in the surrounding communities, there was still two- to four-fold variation in inpatient care use across KP geographic areas. Evidence suggests that more, or more intensive, care for this population is neither necessarily better nor desired by patients. If all California (CA) KP residence areas had the hospital day rate of the average of the lowest three, 2005 decedents would have had more than 50,000 fewer hospital days in their last six months of life. High-intensity care accounts for a large proportion of the overall variation in total costs for this population. This strongly reinforces the focus on appropriate intensive care unit (ICU) use in end-of-life care. Greater emphasis on palliative care approaches for patients with chronic conditions and earlier transition to the use of hospice would create a better match between the expressed desires of patients and the care they receive, thus improving member and family satisfaction as well as quality of care. In addition, earlier transition to hospice in KP could be one important tool for avoiding undesired and nonbeneficial ICU use, given the negative correlation between hospice and ICU use identified in this analysis.

The Permanente Journal

Sponsored by the eight Permanente Medical Groups, The Permanente Journal advances knowledge in scientific research, clinical medicine, and innovative health care delivery.

Reprint Permissions

The Permanente Journal welcomes requests for reprints and reproduction. Use of any and all material published in The Permanente Journal is copyrighted and protected.

The Permanente Press

The Permanente Press publishes The Permanente Journal and books related to healthcare. Journal subscriptions are entered for the calendar year. Advance payment in US dollars is required.


ISSN 1552-5775 Copyright © 2018 thepermanentejournal.org.

The Permanente Press. All Rights Reserved.