title: Organizational determinants of hospital end-of-life treatment intensity.
abstract: BACKGROUND
  There is substantial hospital-level variation in end-of-life (EOL) treatment intensity.
  
  
  OBJECTIVE
  To explore the association between organizational factors and EOL treatment intensity in Pennsylvania (PA) hospitals.
  
  
  METHODS
  Cross-sectional mixed-mode survey of Chief Nursing Officers of PA hospitals linked to hospital-level measures of EOL treatment intensity calculated from PA Health Care Cost Containment Council (PHC4) hospital discharge data. HOSPITALS: One hundred sixty-four hospitals, of which 124 (76%) responded to the survey.
  
  
  METHODS
  : The dependent variable was an index of hospital EOL treatment intensity; the independent variables included administrative data-derived structural and market characteristics and 29 survey-derived hospital or ICU programs, policies, or practices.
  
  
  RESULTS
  : In models restricted to independent variables drawn from administrative sources (available for all 164 hospitals), bed size (P < 0.001), proportion of admissions among black patients (P < 0.001), and county-wide hospital market competitiveness (Herfindahl-Hirschman index) (P = 0.001) were independently associated with greater EOL treatment intensity (adjusted R = 0.5136). In models that additionally included hospital programs, policies, and practices (available for 124 hospitals), only an ICU long length of stay review committee (P = 0.03) was independently associated with greater EOL treatment intensity (adjusted R = 0.5357).
  
  
  CONCLUSIONS
  Information about hospital and ICU programs, policies, and practices believed relevant to the treatment of patients near the end of life offers little additional explanatory power in understanding hospital-level variation in EOL treatment intensity than administratively-derived variables alone. Future studies should explore the contribution of more difficult to measure social norms in shaping hospital practice patterns.
authors.affiliation: Center for Research on Health Care, University of Pittsburgh School of Medicine, 200 Meyran Avenue, Pittsburgh, PA 15213, USA.
authors.forename: Caroline Y
authors.initials: CY
authors.lastname: Lin
authors.forename: Max H
authors.initials: MH
authors.lastname: Farrell
authors.forename: Judith R
authors.initials: JR
authors.lastname: Lave
authors.forename: Derek C
authors.initials: DC
authors.lastname: Angus
authors.forename: Amber E
authors.initials: AE
authors.lastname: Barnato