supply data from Ecological six months of life across the Dartmouth study HRRs Atlas Barnato et 2009 48 physicians from Mixed Treatment plan, al., 2014 two AMCs, using two methods prognosis, diagnosis, case standardized actors of interview and perceptions, and clinical a critically ill 78 year survey of reasoning across AMCs old with metastatic physicians gastric cancer based on a simulated case Tschirhart 2002 to 2008 3,069 HRS decedents Prospective The proportion of et al., HRS linked to over age 65 linked to survey decedents who received 2014 Medicare Medicare claims intubation and claims Retrospective mechanical ventilation, case series of tracheostomy, those who died gastrostomy tub insertion, enteral and parenteral nutrition, or cardiopulmonary resuscitation in the last six months of life Hart et al., April 1, 2011 to 277,693 ICU patient Retrospective Among ICU patients with 2015 December 31, visits in 141 ICUs in cohort survey limitations on 2008 (Project 105 hospitals treatments, the IMPACT ICU proportion who received clinical cardiopulmonary information resuscitation, new forms system) of life support, and the addition or reversal of treatment limitations Table 2: Primary Findings of Included Studies Author Primary Findings Cher and The occurrence of potentially ineffective care was less common among Medicare Lenert, managed care beneficiaries than Medicare fee-service beneficiaries (adjusted odds ratio 1997 [AOR] of 0.75 [95% CI 0.65-0.87]). Pritchard, The percent dying in-hospital varied from 23% to 54% across U.S. Hospital Referral 1998 Regions (HRRs). The risk of in-hospital death increased for residents of regions with
supply data from the Dartmouth Atlas Ecological study six months of life across HRRs Barnato et al., 2014 2009 48 physicians from two AMCs, using two standardized actors of a critically ill 78 year old with metastatic gastric cancer Mixed methods interview and survey of physicians based on a simulated case Treatment plan, prognosis, diagnosis, case perceptions, and clinical reasoning across AMCs Tschirhart et al., 2014 2002 to 2008 HRS linked to Medicare claims 3,069 HRS decedents over age 65 linked to Medicare claims Prospective survey Retrospective case series of those who died The proportion of decedents who received intubation and mechanical ventilation, tracheostomy, gastrostomy tub insertion, enteral and parenteral nutrition, or cardiopulmonary resuscitation in the last six months of life Hart et al., 2015 April 1, 2011 to December 31, 2008 (Project IMPACT ICU clinical information system) 277,693 ICU patient visits in 141 ICUs in 105 hospitals Retrospective cohort survey Among ICU patients with limitations on treatments, the proportion who received cardiopulmonary resuscitation, new forms of life support, and the addition or reversal of treatment limitations Table 2: Primary Findings of Included Studies Author Primary Findings Cher and Lenert, 1997 The occurrence of potentially ineffective care was less common among Medicare managed care beneficiaries than Medicare fee-service beneficiaries (adjusted odds ratio [AOR] of 0.75 [95% CI 0.65-0.87]). Pritchard, 1998 The percent dying in-hospital varied from 23% to 54% across U.S. Hospital Referral Regions (HRRs). The risk of in-hospital death increased for residents of regions with