BMJ  2004;328:1202 (15 May), doi:10.1136/bmj.328.7449.1202

Letter

Use of healthcare resources in the last six months of life

How doctors learn may explain results

The first 150 words of the full text of this article appear below.

EDITOR—Wennberg et al hypothesise that marked variation in use of healthcare resources at the end of life may be explained largely by variations in the supply of doctors and beds.¹ Although this may play an important part, additional explanations are needed.

For example, why does such a large difference exist between New York University Medical Center and Mount Sinai Hospital in the number of intensive care days per decedent if the centres exist in the same city? One clue may be that many of the hospitals that have low numbers of intensive care days per decedent, such as Mount Sinai, University of California San Francisco, and Massachusetts General Hospital, also have active palliative care services with leaders in their field, such as Diane Meier, Steven Pantilat, and Andrew Billings, respectively. Informal social networks are important means by which these palliative care services may have far reaching impacts on . . . [Full text of this article]

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University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637, USA rbernack@medicine.bsd.uchicago.edu

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Relevant Article

Use of hospitals, physician visits, and hospice care during last six months of life among cohorts loyal to highly respected hospitals in the United States

John E Wennberg, Elliott S Fisher, Thérèse A Stukel, Jonathan S Skinner, Sandra M Sharp, and Kristen K Bronner
BMJ 2004 328: 607. [Abstract] [Full Text] [PDF]

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