In 1999, one out of every five Americans died in the hospital using intensive care, and terminal admissions associated with intensive care unit (ICU) admission consumed 80% of all terminal hospitalization costs [
]. Most of these ICU decedents are over age 65. Indeed, the proportion of fee-for-service Medicare beneficiaries with one or more ICU admissions in the last year of life increased from 30.5% in 1985 to 35% in 1999 [
- Angus D.C
- Barnato A.E
- Linde-Zwirble W.T
- Weissfeld L.A
- Watson R.S
- Rickert T
- et al.
The use of intensive care at the end of life in the United States: an epidemiologic study.
Crit Care Med. 2004; 32: 638-643
]. High levels of ICU use at the end of life attract policy attention because of the concern that this care is futile and, hence, wasteful. Yet, these high levels of use are identified retrospectively. The challenge is to predict prospectively which patients will not survive despite ICU care, and for whom averting or interrupting an ICU stay is an acceptable goal. Many mortality prediction models currently exist; how are we to measure the value of these models for informing the utility of ICU care? First, we would expect the prediction tool to be highly reliable. Second, it would have to be available in a timely fashion to inform the decision both to initiate and to continue intensive care. Third, it would have to offer predictions about the outcomes in which patients are most interested. Fourth, it would have to influence clinician behavior. Finally, it would have to help patients and families receive care that is consistent with their preferences.
- Barnato A.E
- Kagay C.R
- McClellan M.C
- Garber A.M
Trends in inpatient treatment intensity among Medicare beneficiaries at the end of life.
Health Serv Res. 2004; 39: 359-372
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- The use of intensive care at the end of life in the United States: an epidemiologic study.Crit Care Med. 2004; 32: 638-643
- Trends in inpatient treatment intensity among Medicare beneficiaries at the end of life.Health Serv Res. 2004; 39: 359-372
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☆Funding by the Robert Wood Johnson Foundation; National Institute on Aging, Grant # 1 K08 AG021921-01.
© 2004 Elsevier Inc. Published by Elsevier Inc. All rights reserved.