Primary Care Involvement Reduces Intensity, Cost of End-of-Life Care

High primary care physician involvement during the last 6 months of a patient’s life is associated with less intensive and less costly care, according to a study in the Annals of Family Medicine.

Researchers from the Robert Wood Johnson Clinical Scholars Program at the University of Michigan Health System and the Robert Graham Center came to their findings after analyzing 2010 Medicare Part B claims data for 306 US hospital reference regions. The data spanned 1,107,702 patients with chronic disease who had died.

Adults with chronic illness who lived in regions with high primary care physician involvement in end-of-life care, according to the study, experienced less time in the intensive care unit during their last 6 months of life, were less likely to have more than 10 physicians involved in their care, and had less costly end-of-life care than those in areas with low primary care physician involvement.

Hospital reference regions with more involvement of primary care physicians had lower Medicare spending during the final 2 years of life ($65,160 compared with $69,030 in areas where primary care involvement was low), the study found. In the final 6 months of life, patients in regions with high primary care involvement had, on average, 2.9 days in the intensive care unit compared with 4.3 days for patients in regions with low primary care input. 

Greater physician involvement in end-of-life care was also linked with lower rates of hospice use. Hospice enrollment for patients was 45% in regions with greater primary care involvement compared with 50% in regions with low involvement, the study found.   

“The finding that greater primary care physician involvement is associated with less hospice use is a paradox worthy of further investigation, with several possible explanations,” researchers wrote. “Primary care physicians may hesitate to refer to hospice if doing so is perceived as terminating a long-standing relationship. Alternatively, primary care physicians may not recognize patients as having a prognosis of less than 6 months because of their long-standing relationship.”

Researchers concluded that better optimization of primary care physicians at the end of life could reduce costly, unnecessary intensive care and also improve the experience of patients who are dying.—Jolynn Tumolo