Wednesday, May 17, 2006

WSJ article on days in ICU before death

There is an article in the May 16th WSJ (Wall Street Journal, as opposed to the other WSJ I know, the Winston-Salem Journal) on D1 regarding the increased cost at certain academic/tertiary care hospitals. The article is referring to a Dartmouth Study that looked at the number of days in the ICU or hospital for patients in the 6 months before their death for 12 chronic medical conditions.

The national average for days in ICU in the 6 months before death was 3.6 days, but UCLA and Thomas Jefferson Med Centers were above 11. Now there may obviously be some selection bias and I have not read the primary report to see if they adjusted for the fact that patients at academic/tertiary care centers may have more aggressive goals.

Well the study is not the most interesting point. The most interesting point is that palliative care got mentioned. At the very end (ironic?). But here is the quote from the Chief Medical Officer at NYU, Dr. Max Cohen:

"There are very distinct patient and family preferences, and major differences in the culture of different patient populations" that explain some of the above-average use of services, he says. But he adds that the hospital has established "a palliative-care service which we hope can be effective in limiting overuse of resources, where a patient has a terminal disease." (emphasis mine)

Ack! I can't tell you exactly what problem I have with this because I have submitted a letter to the WSJ for publication to better explain what palliative care is. But feel free to discuss in the comment section below.

If the WSJ does not publish my letter, I may show it here for commentary. If anyone knows Dr. Max Cohen, please send him over here. This may have been selective quoting for the article focusing on financial issues, and I am sure he explained much more about the true goals of a palliative care team.

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