Hospital bed rate decides where people die

By far, the number of hospital beds in a community is the strongest determinant in whether a terminally ill patient dies in the hospital or at home, according to a new study published in the October issue of the Journal of the American Geriatrics Society.

Analysis of the wide geographic disparities in end-of-life care challenges current assumptions about the choices patients might make if they were armed with better information. The assumptions are based on data from the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT), a multisite study funded by the Robert Wood Johnson Foundation in Princeton, NJ, and the Dartmouth Atlas of Health Care, produced at the Dartmouth Medical School in Hanover, NH.

The study indicates that unless local health care resources and practice styles are adjusted to meet the needs of dying patients, their wishes likely will not prevail. More than 80% of SUPPORT patients said they would prefer to die at home, but 55% of them died in a hospital. Nationally, 39% of all deaths in 1992 and 1993 were in a hospital; but this rate varied from 22% in Portland, OR, and Ogden, UT, to 54% in Newark, NJ.

Medicare data suggest that a decrease of just one hospital bed per thousand population decreases the in-hospital death rate by 3.8%, while increased spending on hospice also corresponds with a lower rate of in-hospital deaths.