Researchers identified patients attending 77 hospitals that appeared on the 2001 US News and World Report "best hospitals" list for chronic illness and geriatric care. Use of healthcare resources by these patients during the last six months of life was measured.

The intensity of care during the last six months of life and at the time of death varied substantially, even among hospitals in the same region. Time spent in hospital ranged from less than 10 days to 27 days, and time in intensive care units ranged from less than two days to almost 10 days.

The percentage of deaths occurring in hospital ranged from less than 16% to more than 55%, and the percentage of deaths associated with a stay in intensive care ranged from less than 9% to more than 36%.

Variations in end of life care among the best hospitals in the United States raise further questions about the appropriate role for acute hospital care in the management of chronically ill patients, conclude the authors.

These findings should make policy makers wary of unleashing further, often ill considered, reforms on health systems, writes Professor David Hunter in an accompanying commentary.

They also prompt concerns about whether the UK government's commitment to providing 9,500 more doctors and increasing capacity by 7,000 beds is entirely wise or appropriate if having more of them doing much the same sort of work in the same way is no guarantee of better health.

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Contact: Emma Dickinson
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BMJ-British Medical Journal
11-Mar-2004