End-of-life: When too much care is a poor outcome

Atlas editor has firsthand knowledge of problem

In her last months of life, Megan McAndrew Cooper’s mother had a mammogram, colon-oscopy, and cataract surgery. It brought home an issue Cooper has revealed in greater detail as editor of the Dartmouth Atlas of Health Care — 1999: Patients at the end of life often receive more medical care than they want or need.

Cooper’s mother was on oxygen, suffering from radiation-induced pulmonary hypertension and congestive heart failure. "Someone sent her for a mammogram, but they weren’t thinking about why they were sending her for a test they couldn’t do anything about," Cooper says. "It brings up some pretty important questions about what happens at the end of life."

Cooper’s mother died almost two years ago. In the Atlas, which was released this spring, Medicare data shows that the number of visits to physicians in the last six months of life range from an average of less than nine to almost 50.

The chance of being admitted to an intensive care unit at the time of death ranged from 6.3% to almost 30%. The comparisons are based on 306 hospital referral regions that are based on patterns of care.

"Is anyone thinking about whether that’s quality of life or quality of care?" wonders Cooper.

In fact, Cooper asserts that the Medicare program has sufficient financial resources if money isn’t wasted on care that isn’t necessary or not what patients want.

"It is appalling that we’re spending all these resources to send my mother for a mammogram but not sending diabetics for an eye exam that could keep them from getting blind," she says.