title: Is futile care in the injured elderly an important target for cost savings?
abstract: BACKGROUND
  This study proposes a definition of futile care and quantifies its cost in injured elders.
  
  
  METHODS
  This was a retrospective study of Medicare patients with an International Classification of Diseases-9 injury diagnosis admitted to 171 Oregon and Washington facilities from January 1, 2001, through December 31, 2002, who died within 6 months of admission. Futile care was defined as death within 7 days of discharge from a hospitalization of at least 14 days. We compared health care costs in the last 6 months of life with those who did and did not meet our definition of futility. To simulate predicting and preventing futility early in the hospital course, we examined the effect of reducing spending on the futile care cohort to the level of those who survived 7 to 10 days after injury.
  
  
  RESULTS
  There were 6,832 elders who died within 6 months of injury, of whom 230 (3.4%) met our definition of futility. The median cost of care in the last 6 months of life was $33,373 for those not meeting our definition of futility and $87,391 for the futile care group (p < 0.001). The 3.4% receiving futile care incurred 8.9% of total costs. Reducing expenditures in the futile care group to the level of those who died from 7 to 10 days after injury (median, $25,633) would result in an overall cost savings of 6.5%.
  
  
  CONCLUSIONS
  End-of-life health care costs were significantly higher for those who received futile care. However, even aggressive reductions in futile care would result in small savings overall.
  
  
  METHODS
  Economic analysis, level III.
authors: Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA. fleischr@ohsu.edu
authors: Ross J
authors: RJ
authors: Fleischman
authors: Richard J
authors: RJ
authors: Mullins
authors: K John
authors: KJ
authors: McConnell
authors: Jerris R
authors: JR
authors: Hedges
authors: O John
authors: OJ
authors: Ma
authors: Craig D
authors: CD
authors: Newgard
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017046:Cost Savings / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D018447:Medical Futility; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013727:Terminal Care / Q000191:economics / Q000706:statistics & numerical data; D014481:United States; D014947:Wounds and Injuries / Q000191:economics* / Q000401:mortality