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First-of-its-kind Dartmouth study compares end-of-life care between seven countries

Union Leader Correspondent

January 19. 2016 10:23PM

LEBANON — There was no clear leader in a first-of-its-kind comparative study released Tuesday of seven developed countries’ approach to end-of-life care.

“There’s no one country that stands out as, ‘they have it all figured out and we should all do what they do,’” said one of the lead researchers of the study, Julie Bynum, from the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon.

Bynum was part of an international research team, which included other researchers from the Dartmouth Institute for Health Policy and Clinical Practice as well as researchers from the University of Pennsylvania’s Perelman School of Medicine.

The researchers used data from 2010 to 2012 to compare end-of-life care in Belgium, Canada, England, Germany, the Netherlands, Norway and the United States.

The study focused on end-of-life care in these countries for patients dying of cancer.

The study is the first of its kind because in the past collecting and comparing medical data from different countries has been too difficult to achieve.

“Doing international studies on health care used to be a very big challenge because we all have different data systems,” Bynum said.

Measurements included hospitalizations, intensive care unit or ICU admissions, ER visits and chemotherapy treatments in the last six months of life, as well as hospital expenditures paid by government or commercial insurers.

One of the facts that stood out in the study was that if you are a terminally ill patient in the United States, you are less likely to die in a hospital than you would if you lived in these other developed nations, she said.

It’s hard to pinpoint exactly why since it seems a mix of cultural and historical factors in these countries as well as how medical fees get paid contribute to the end results.

“That’s what makes this so interesting — it’s all paid through different ways,” Bynum said. “It’s not simply how we pay for care.”

For some reason in the United States, hospital stays are limited as much as possible and terminal patients are either returned home or transferred to nursing homes.

Hospitals in these other countries continue to play a more traditional role in end-of-life care.

“They use their hospitals differently than we do. We really focus on getting people out of our hospitals as fast as we can,” Bynum said.

While these terminally ill patients with cancer in the United States spend less time in the hospital, they are more likely to receive costly, high-tech care and are twice as likely to be admitted to the ICU, Bynum said.

In the last six months of life, 40 percent of U.S. patients with cancer were admitted to the ICU compared with less than 18 percent in the other countries that were part of the study.

Similarly, 40 percent of U.S. patients received chemotherapy at least once in the last six months of life, second only to Belgium.

The United States ranks third-highest in average per-patient hospital expenditure in the last six months of life with $18,500, with only Canada, at $21,840, and Norway, at $19,783, spending more.

The most surprising thing to come out of the study is that no one country faired better. Ultimately, dying of cancer in any of these countries is a costly drain on resources, Bynum said.

Bynum said comparing care, however, is the first step toward perhaps improving end-of-life care.

“No country has figured out end-of-life care,” she said. “There’s no magic bullet.”

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