Patients who die in the hospital in the United States are almost five times as likely to have spent part of their last hospital stay in the ICU than patients in England. What's more, over the age of 85, ICU usage among terminal patients is eight times higher in the U.S. than in England, according to new research from Columbia University that compared the two countries' use of intensive care services during final hospitalizations.
"Evaluating the use of intensive care services is particularly important because it is costly, resource intensive, and often traumatic for patients and families, especially for those at the end of life" said Hannah Wunsch, M.D., M.Sc., assistant professor of anesthesiology and critical care medicine, of Columbia University, lead author of the study. "We found far greater use of intensive care services in the United States during terminal hospitalizations, especially among medical patients and the elderly."
Their findings were published in the November 1 issue of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.
Dr. Wunsch and colleagues wanted to examine the differences in ICU usage in England and the U.S., because the countries' similar life expectancies and population demographics enabled a comparison of fundamentally different healthcare systems.
England has one-sixth the number of intensive care beds available per capita that are available in the U.S. Furthermore, medical decisions in England are generally considered to be the direct responsibility of the physician, rather than that of the patient or the patient's surrogate decision-maker(s) as it is in the U.S.
"In England, there is universal health care through the National Health Service, and there is also much lower per-capita expenditure on intensive care services when compared to the U.S.," said Dr. Wunsch. "The use of intensive care in England is limited by supply
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American Thoracic Society