Valued Care: End of Life Care and Early Trends from “Choosing Wisely”

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This week, Amol and Dr. Kieran Quinn, both general internal medicine residents at the University of Toronto, discuss two studies:

Where do people die? What types of care do they utilize at the end of life? A retrospective cohort study of people who died with cancer in seven developed countries evaluated the number of deaths that occur in acute care hospitals, care utilization at the end of life and hospital expenditures. Among their findings, Canada was among the countries with the highest death rates in acute care hospitals and highest costs per capita in the last months of life. Kieran and Amol consider the limitations of the study, and opportunities to improve end of life care.

“More medicine is not better medicine” is the message “Choosing Wisely” has been spreading since 2009. But what has been the effect of the campaign since its initiation? A retrospective analysis of insurance claims in the United States assessed early trends of seven “Choosing Wisely” recommendations, and found that there was no real difference in any of these services. Amol and Kieran discuss what the results mean for the campaign.

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The Papers

1. End of life care: http://jama.jamanetwork.com/article.aspx?articleid=2482325

2. “Choosing Wisely” early trends: http://www.ncbi.nlm.nih.gov/pubmed/26457643

Good Stuff

1. http://www.cbc.ca/news/business/brain-zapping-devices-health-1.3562621

2. http://www.theatlantic.com/health/archive/2016/05/the-small-town-that-became-the-us-capital-of-hiv/480984/?utm_source=SFTwitter

Music Credits (Creative Commons)

In your Robotic Heart – Nicolai Heidlas https://soundcloud.com/nicolai-heidlas/in-your-robotic-heart

Drive – Nicolai Heidlas https://soundcloud.com/nicolai-heidlas/drive-fresh-upbeat-pop-background-music

Vintage Dream – Nicolai Heidlas https://soundcloud.com/nicolai-heidlas/vintage-dream-loungejazzy-background-music

All tracks have been modified for the purposes of this podcast.

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