Designated cancer centers perform little better on National Quality Forum (NQF) end-of-life cancer care measures than non-designated centers and hospitals, according to a Dartmouth Atlas study in Health Affairs.
Hypothesis: Cancer centers do better at end-of-life care
Study author Nancy Morden initially expected that specialized cancer centers would better follow end-of-life cancer care measures and deliver less intensive inpatient care, the Washington Post reports.
To test that theory, Morden and other Dartmouth researchers examined Medicare data for 215,311 patients with aggressive or metastatic cancer at 4,444 U.S. hospitals between 2003 and 2007. Specifically, they assessed performance across 11 end-of-life care measures, comparing care provided in the last six months of each patient's life at:
- Centers in the National Comprehensive Cancer Network (NCCN);
National Cancer Institute (NCI)-designated cancer centers outside NCCN;
- Academic medical centers (AMCs); and
- Community hospitals.
Morden's team found that all patients, irrespective of facility, tended to receive a high volume of inpatient services in their last six months.
- How would your organization fare on end-of-life care? As quality data is increasingly benchmarked and made publicly available, cancer programs must prepare themselves for new scrutiny on performance and adherence to quality measures. Learn more at the Oncology Roundtable's national meeting.
Should there be more focus on hospice?
Challenging Morden's hypothesis, researchers concluded that, "hospitals with a specific clinical focus on cancer care, such as [NCCN] and [NCI] centers, differ only modestly in their end-of-life care patterns from hospitals that do not have such a focus."
Notably, researchers uncovered a significant difference in end-of-life care on only four end-of-life measures:
- NCCN centers did outperform the other three hospital types on the percentage of patients initiated into hospice care within the last three days of life and the percentage of patients who received care in the ICU within the last month of life.
- NCCN centers, NCI-designated centers, and AMCs outperformed community hospitals on the NQF measure assessing the percentage of patients who received chemotherapy in their last two weeks of life.
- NCI-designated centers and AMCs performed more procedures that could potentially prolong patients' lives than NCCN centers and community hospitals.
Given the high volume of end-of-life inpatient care, study authors determined that each hospital must "examine the care it provides to patients believed to be near death, and question its alignment with patient preferences—whether they be for early supportive care or aggressive treatment in the last days of life."
"I think people don’t understand the difference between rationing, and between quality of care at the end of life," Morden told the Post. Patients and physicians "equate hospice to giving up inappropriately when, sometimes, it’s the decision the patient wants" (Morden et al., Health Affairs, Zigmond, Modern Healthcare, 4/9 [subscription required]; Kliff, Washington Post, 4/10).