Formal discussant of this abstract, Deborah Schrag, MD, MPH, Dana-Farber Cancer Institute, praised this effort.

“Dr. Stuver’s abstract provides ample evidence of overuse of intensive care at the end of life. Patients and their families do not want to be in the hospital or emergency department at the end of life. Interventions to curb overuse of intensive care have the potential to provide better care, improved patient experience, and less expense, all at the same time. If we can identify patients at risk and specific aspects of overuse, hopefully we can direct strategic interventions that will have impact.”

Dr. Stuver and colleagues used quality metrics developed by the National Quality Forum to evaluate the quality of care received by patients with commercial health insurance. “Now that [use] of intensified end-of-life care is an identified problem, it is time to develop and test interventions,” she said.

There is a broad range of potential interventions including benchmarking and peer feedback, detailing and proactive case management of high-risk patients, remote monitoring systems that leverage technology, clinical decision support embedded in electronic medical records, early involvement of palliative care, systematic case review and team support, and conversations about culture change. ■

Disclosure: Dr. Schrag reported no potential conflicts of interest.