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Fewer patients may be dying in hospitals, but that doesn't necessarily mean they are getting better. More may be dying in hospices or nursing homes or even at home, experts say.
The number of people who died in the hospital has fallen just 8 percent over 10 years, despite a big emphasis on letting people die in hospice or even at home, new federal statistics show.
And a lot of the decrease appears to be from an overall drop in many types of death, the new report from the National Center for Health Statistics shows.
“People don’t want to die in the hospital – yet a lot of them are,” says NCHS’s Margaret Jean Hall, who led the study with colleagues Shaleah Levant and Carol DeFrances.
The study found another trend – deaths in the hospital from sepsis, an overwhelming immune response to infection or injury, rose 17 percent over those 10 years. Other data shows sepsis cases overall more than doubled over that time.
Hall and her colleagues pulled their data from an annual survey done by the Centers for Disease Control and Prevention on nonfederal, noninstitutional, short-stay hospitals and general hospitals.
“The number of inpatient hospital deaths decreased 8 percent from 776,000 in 2000 to 715,000 in 2010,” they wrote in their report. “At the same time, total hospitalizations increased 11 percent, from 31.7 million in 2000 to 35.1 million in 2010.”
People with several conditions were far less likely to die in a hospital , the team found. “Hospital death rates decreased for patients hospitalized for respiratory failure by 35 percent, for pneumonitis due to solids and liquids by 22 percent, for kidney disease by 65 percent, for cancer by 46 percent, for stroke by 27 percent, for pneumonia by 33 percent, and for heart disease by 16 percent,” they wrote.
“We know that overall death rates are down for some of these conditions … for example, the cancer death rate, the stroke death rate,” Hall said in a telephone interview.
“But it doesn’t necessarily mean we are better at getting people well in the hospital. They could just have gone to a post-acute setting like a nursing home…or even home and they could have died soon after,” she added.
It’s well established that hospitals are not necessarily the best place for people who are dying. They are very expensive places to get care, and staff may be less focused on making patients comfortable than on keeping them alive – even if they are ultimately almost certainly going to die soon.
“Sometimes they get care that is more intensive than what they would have requested,” Hall said.
Hospice care aims to keep patients comfortable when it’s clear that their conditions are incurable. Other alternatives to the hospital for patients who may not necessarily be dying include nursing homes, long-term care facilities and home care.
Theresa Forster, vice president for hospice policy at the National Association for Home Care & Hospice, says while an 8 percent reduction in hospital inpatient deaths over 10 years may not be a huge number, it’s at least moving in the right direction.
“This could be the beginning of significant change,” Forster said in a telephone interview.
“We are getting a whole lot better but we still have a long way to go,” she added. “I think the American public very much desires there to be more discourse around this whole area, and they want to be talking more with their doctors.”
Forster noted that Congress and the federal government have only recently created financial incentives for hospitals to move dying patients to other facilities, as part of efforts to reduce what are called readmission rates – when patients are discharged, and then wind up right back in the hospital a few days or weeks later.
Last month, CDC reported more people are dying at home. The study looked at Medicare patients – a different population of people than Wednesday’s report covers. It found that 33.5 percent of Medicare patients died at home in 2009, compared to 23 percent in 2000.
As for the findings on sepsis, also known as septicemia, Hall says it’s not clear how much of the rise is due to more cases occurring.
"More people are recognizing sepsis," says Dr. Clifford Deutschman of the University of Pennsylvania, a past president of the Society of Critical Care Medicine. Deutschman says hospitals are doing a better job of classifying deaths from sepsis, a still mysterious condition in which the body's immune system gets out of whack, often killing patients in just hours or days.
Hall and colleagues reported in 2011 that both the number and rate of people hospitalized with sepsis more than doubled from 2000 through 2008, from 326,000 in 2000 to 727,000 in 2008. But if deaths only went up 17 percent over a period two years longer, that could indicate that hospitals are doing a good job of saving sepsis patients. Quick recognition and treatment is key, says the Surviving Sepsis Campaign.
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