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Original Investigation |

The Frequency and Cost of Treatment Perceived to Be Futile in Critical Care

Thanh N. Huynh, MD, MSHS1; Eric C. Kleerup, MD1; Joshua F. Wiley, MA2; Terrance D. Savitsky, MBA, MA, PhD3; Diana Guse, MD4; Bryan J. Garber, MD4; Neil S. Wenger, MD, MPH3,5
[+] Author Affiliations
1Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles
2Institute for Digital Research and Education, Department of Psychology, University of California Los Angeles
3RAND Health, Santa Monica, California
4Department of Medicine, David Geffen School of Medicine, University of California Los Angeles
5Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles
JAMA Intern Med. 2013;173(20):1887-1894. doi:10.1001/jamainternmed.2013.10261.
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Importance  Physicians often perceive as futile intensive care interventions that prolong life without achieving an effect that the patient can appreciate as a benefit. The prevalence and cost of critical care perceived to be futile have not been prospectively quantified.

Objective  To quantify the prevalence and cost of treatment perceived to be futile in adult critical care.

Design, Setting, and Participants  To develop a common definition of futile care, we convened a focus group of clinicians who care for critically ill patients. On a daily basis for 3 months, we surveyed critical care specialists in 5 intensive care units (ICUs) at an academic health care system to identify patients whom the physicians believed were receiving futile treatment. Using a multivariate model, we identified patient and clinician characteristics associated with patients perceived to be receiving futile treatment. We estimated the total cost of futile treatment by summing the charges of each day of receiving perceived futile treatment and converting to costs.

Main Outcome and Measure  Prevalence of patients perceived to be receiving futile treatment.

Results  During a 3-month period, there were 6916 assessments by 36 critical care specialists of 1136 patients. Of these patients, 904 (80%) were never perceived to be receiving futile treatment, 98 (8.6%) were perceived as receiving probably futile treatment, 123 (11%) were perceived as receiving futile treatment, and 11 (1%) were perceived as receiving futile treatment only on the day they transitioned to palliative care. The patients with futile treatment assessments received 464 days of treatment perceived to be futile in critical care (range, 1-58 days), accounting for 6.7% of all assessed patient days in the 5 ICUs studied. Eighty-four of the 123 patients perceived as receiving futile treatment died before hospital discharge and 20 within 6 months of ICU care (6-month mortality rate of 85%), with survivors remaining in severely compromised health states. The cost of futile treatment in critical care was estimated at $2.6 million.

Conclusions and Relevance  In 1 health system, treatment in critical care that is perceived to be futile is common and the cost is substantial.

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Patients and Assessments Included in the Study
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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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