At the end of life, people in Oregon are more likely to have their care wishes honored, less likely to be hospitalized and more likely to use home hospice services compared with people in Washington and the rest of the U.S.

That’s according to a new report in the New England Journal of Medicine co-authored by OHSU’s Susan Tolle, M.D.

“The level of care you receive near the end of life depends more on the state you live in and the systems they have in place than your actual wishes,” Tolle said to reporters. She is director of the OHSU Center for Ethics in Health Care and co-creator of the Physician Orders for Life-Sustaining Treatment, or POLST Program.

She and co-author Joan Teno, M.D., M.S., of the University of Washington, looked at utilization trends for Medicare fee-for-service. The patterns are strikingly different in Oregon, as shown in the above figure from the paper. The work was supported by a grant from the Robert Wood Johnson Foundation.

To improve end-of-life care, Oregon has made a series of policy changes and educational efforts over the years. Tolle and Teno review those changes and outline lessons learned from Oregon’s successes. “Transforming care near the end of life requires a willingness to forgo the temptation of an easy fix,” the authors said.

“Until we embrace the complexity of this social interaction, the need for multifaceted interventions, and the application of public health strategies, we will fail to make the needed improvements in care at the close of life.”

You can read more about the work at OHSU News.

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Citation

Lessons from Oregon in Embracing Complexity in End-of-Life Care by Susan W. Tolle and Joan M. Teno, New England Journal of Medicine (March 16, 2017)