|Regional Variations in End of Life Care and Costs: Cultures of Medicine or Structures of Caregiving?|
Award Year: 2011
Americans facing serious illness receive different care, at different costs, and with different outcomes based on where they live. Since the 1970s researchers from a number of groups, most notably John Wennberg, Elliott Fisher and David Goodman at the Dartmouth Institute for Health Policy & Clinical Practice, have made a compelling case that the use of medical services and procedures varies widely from community to community for reasons not fully accountable by medical need, not clearly related to evidence or medical outcomes, and likely substantially influenced by supply. Carla C. Keirns, M.D., Ph.D., draws on her clinical experience and her scholarship in her Investigator Award Project, Regional Variations in End of Life Care and Costs: Cultures of Medicine or Structures of Caregiving? Exploring how individuals and families navigate health care, Dr. Keirns studies source of regional variation in end of life care and costs not only in the local structures and cultures of medical practice, but also in patterns of housing, employment, and family structure that impact the choices available to patients at the end of life—particularly the feasibility home hospice care. This work draws from both a growing literature on decision-making, costs, and patterns of end-of-life care, and a deep and extensive literature on local cultures of medical practice from many disciplines. Drawing on her experience as a historian, sociologist, and health services researcher, as well as a practicing palliative care physician, she uses health utilization data, interviews and community studies to make sense of individual choices and regional patterns which are fundamental to understanding how to empower patients, improve care and reduce costs.