0
ARTICLE |

Aggressive Medical Care at the End of Life: Title and subTitle BreakDoes Capitated Reimbursement Encourage the Right Care for the Wrong Reason? FREE

J. Randall Curtis, MD, MPH; Gordon D. Rubenfeld, MD, MS
[+] Author Affiliations

Reprints: J. Randall Curtis, MD, MPH, Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, Box 359762, 325 Ninth Ave, Seattle, WA 98104 (e-mail: jrc@u.washington.edu).


JAMA. 1997;278(12):1025-1026. doi:10.1001/jama.1997.03550120085041
Text Size: A A A
Published online

The quality of medical care at the end of life is receiving increased attention in both the popular press1 and professional journals.2,3 This interest has developed in part because of the perception that people die with ineffective, painful, expensive, and unwanted medical interventions that deprive them of their dignity, personal interactions, and family savings. This perception is not wholly unfounded. Approximately 60% of Americans die in hospitals.4 Among the deaths of hospitalized patients in the SUPPORT study,5 half died after receiving mechanical ventilation for more than 1 week. Many families of dying patients report that their loved ones experience moderate to severe pain during most or all of the loved ones' last few days. Many of the families of dying patients experience severe caregiving and financial burdens.6 Efforts to improve the quality of end-of-life care through advance directives, education, and more accurate prognostic information have

REFERENCES

Brink S.  The American way of dying . US News & World Report . (December 4) ,1995;: 70-75.
Hanson LC, Tulsky JA, Danis M.  Can clinical interventions change care at the end of life? Ann Intern Med . 1997;;126:381-388.
Miles SH, Koepp R, Weber EP.  Advance end-of-life treatment planning: a research review . Arch Intern Med . 1996;;156:1062-1068.
Field MJ, Cassel CK. Approaching Death: Improving Care at the End of Life: Institute of Medicine Report . Washington, DC: National Academy Press; 1997;.
The SUPPORT Principal Investigators.  A controlled trial to improve care for seriously ill hospitalized patients: the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) . JAMA . 1996;;274:1591-1598.
 Correction : JAMA . 1996;;275:1232.
Covinsky KE, Goldman L, Cook EF, et al.  The impact of serious illness on patients' families . JAMA . 1994;;272:1839-1844.
Schneiderman LJ, Kronick R, Kaplan RM, Anderson JP, Langer RD.  Effects of offering advance directives on medical treatment and costs . Ann Intern Med . 1992;;117:599-606.
Danis M, Southerland LI, Garrett JM, et al.  A prospective study of advance directives for life-sustaining care . N Engl J Med . 1991;;324:882-888.
Cher DJ, Lenert LA.  Method of Medicare reimbursement and the rate of potentially ineffective care of critically ill patients . JAMA . 1997;;278:1001-1007.
Unstable Angina Guideline Panel. Unstable angina: diagnosis and management. In: Clinical Practice Guidelines. Rockville, Md: US Dept of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research and the National Heart, Lung, and Blood Institute; 1994. AHCPR publication 94-0602.
American Thoracic Society.  Guidelines for the initial management of adults with community-acquired pneumonia: diagnosis, assessment of severity, and initial antimicrobial therapy . Am Rev Respir Dis . 1993;;148:1418-1426.
Hoffman JC, Wenger NS, Davis RB, et al.  Patients' preferences for communication with physicians about end-of-life decisions . Ann Intern Med . 1997;;127:1-12.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

Brink S.  The American way of dying . US News & World Report . (December 4) ,1995;: 70-75.
Hanson LC, Tulsky JA, Danis M.  Can clinical interventions change care at the end of life? Ann Intern Med . 1997;;126:381-388.
Miles SH, Koepp R, Weber EP.  Advance end-of-life treatment planning: a research review . Arch Intern Med . 1996;;156:1062-1068.
Field MJ, Cassel CK. Approaching Death: Improving Care at the End of Life: Institute of Medicine Report . Washington, DC: National Academy Press; 1997;.
The SUPPORT Principal Investigators.  A controlled trial to improve care for seriously ill hospitalized patients: the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) . JAMA . 1996;;274:1591-1598.
 Correction : JAMA . 1996;;275:1232.
Covinsky KE, Goldman L, Cook EF, et al.  The impact of serious illness on patients' families . JAMA . 1994;;272:1839-1844.
Schneiderman LJ, Kronick R, Kaplan RM, Anderson JP, Langer RD.  Effects of offering advance directives on medical treatment and costs . Ann Intern Med . 1992;;117:599-606.
Danis M, Southerland LI, Garrett JM, et al.  A prospective study of advance directives for life-sustaining care . N Engl J Med . 1991;;324:882-888.
Cher DJ, Lenert LA.  Method of Medicare reimbursement and the rate of potentially ineffective care of critically ill patients . JAMA . 1997;;278:1001-1007.
Unstable Angina Guideline Panel. Unstable angina: diagnosis and management. In: Clinical Practice Guidelines. Rockville, Md: US Dept of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research and the National Heart, Lung, and Blood Institute; 1994. AHCPR publication 94-0602.
American Thoracic Society.  Guidelines for the initial management of adults with community-acquired pneumonia: diagnosis, assessment of severity, and initial antimicrobial therapy . Am Rev Respir Dis . 1993;;148:1418-1426.
Hoffman JC, Wenger NS, Davis RB, et al.  Patients' preferences for communication with physicians about end-of-life decisions . Ann Intern Med . 1997;;127:1-12.
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.