Examining the Causes and Consequences of Multiple Healthcare Transitions at the End of Life

The Multiple Transitions research team, led by Joan Teno, MD, is conducting policy relevant research to examine variation in the rate and type of healthcare transitions experienced by long term care recipients in the US and to examine the role of state policies and market characteristics on transition rates.

The first published paper from this project reveals the rate of health care transitions vary substantially across the US and that regions with higher transition rates are more likely to utilize a medical procedure of questionable value, such as feeding tubes in persons with advanced cognitive impairment. Our preliminary results attest to the substantial variation of health care transitions in the last 90 days of life even among persons with advanced cognitive impairment. At the MDS completed 3 months prior to death, 41% had swallowing problems indicating the terminal stages of this illness. Finally, the aggressiveness of the local medical culture and state policy impact on the rate of health care transitions suggesting the need for multifaceted interventions that address these and other modifiable factors that promote appropriate health care transitions consistent with the wishes of these patients as noted in written advance directives or their proxy decision maker in last days of their life.

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