Area of work:
Commissioning, Research methods & information tools

The quality of end of life care is important to patients, their friends and relatives. Yet it presents major challenges for health systems, in particular in helping people to access care in the place they choose. This project looks at the degree of variation in hospital use at the end of life, and examines the factors associated with these variations.

There are huge variations in medical practice and in the use of health services for people at the end of their lives.

A 2004 study of high performing medical centres in the United States by Wennberg and colleagues found striking differences in the use of hospital services in the last six months of life between one hospital centre and another. These patterns showed, for example, an almost three-fold difference in the number of days spent in hospital between different hospital centres. These variations were thought to be due in large part to differences in the levels of the local hospital workforce and the availability of hospital beds.

A study in the US found a three fold difference  in the level of hospital use in the last six months of life

The Nuffield Trust has been working with Professor John Billings from New York University to undertake a study of acute care at the end of life in England. This work is looking at the factors associated with variation in hospital use at the end of life.

The study exploits the anonymised (to protect patients’ identities) electronic records of more than 1.2 million people who died during a three year period. The work is testing for variation between different acute hospital providers and hospital types, by diagnostic groups, by age, sex and ethnicity and by local areas of residence.

The findings from this research project will be published in 2012 and we expect they will raise important concerns for policy-makers.

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