End-of-life Care in the ICU: Can We Simultaneously Increase Quality and Reduce Costs?

Publication Type:

Journal Article

Source:

American journal of respiratory and critical care medicine (2012)

Keywords:

August 2012, Public Health Sciences Division

Abstract:

The incidence and costs of critical illness are increasing in the US at a time when there is a focus both on limiting the rising costs of healthcare and improving the quality of end-of-life care. Over 25% of healthcare costs are spent in the last year of life and approximately 20% of deaths occur in the ICU. Consequently, there has been speculation that end-of-life care in the ICU represents an important target for cost savings. It is unclear whether efforts to improve end-of-life care in the ICU could significantly reduce healthcare costs. Here, we summarize recent studies suggesting that important opportunities may exist to improve quality and reduce costs through two mechanisms: advance care planning for patients with life-limiting illness and use of time-limited trials of ICU care for critically ill patients. The goal of these approaches is to ensure patients receive the intensity of care that they would choose at the end of life, given the opportunity to make an informed decision. Although these mechanisms hold promise for increasing quality and reducing costs, there are few clearly described, effective methods to implement these mechanisms in routine clinical practice. We believe basic science in communication and decision-making, implementation research, and demonstration projects are critically important if we are to translate these approaches into practice and, in so doing, provide high-quality and patient-centered care while limiting rising healthcare costs.