Don't they know it's the end of the world.... Skeeter Davis sings in one of our favorite songs of loss and heartbreak. The End of the World can also be considered a song about end of life care. The headlines about the new report from Dartmouth University looks at the records of over two hundred and thirty thousand (235,821) patient records at their end of life. When its you or your loved ones. The end of the world is the end of life. It was her end of life care of PearlieMae that resulted in the creation of this site. What PearlieMae didn't want was to die in a nursing home or a hospital unfortunately that fear was realized to our great regret.
"Most patients with serious illness prefer to be at home at the end of life, in familiar settings and close to family. However, across the United States, about 29% of cancer patients who died during the period from 2003 to 2007 did so in a hospital." - The Dartmouth Atlas of Health Care (Percent of Patients Dying in Hospital)
PearlieMae was like most patients. Unfortunately where she lived determined where she'd die. We knew this but she succumbed to her cancer before relocating to the region's least likely areas (Asheville, NC area). The Carolinas are also the areas most know for producing tobacco long considered responsible for cancer. The region's most likely areas (Columbia, SC area) to succumb to the disease in a hospital. The metropolitan area is often considered the "tri-state." However for the purposes of the Dartmouth data the District of Columbia is composed of a different "tri-state." For the purposes of this study, rather than as it's residents, DC's data is drawn from Annapolis to West Virginia but excludes Virginia.
"The use of health care resources in the United States is highly localized. Most Americans use the services of physicians whose practices are nearby. Physicians, in turn, are usually affiliated with hospitals that are near their practices. As a result, when patients are admitted to hospitals, the admission generally takes place within a relatively short distance of where the patient lives. This is true across the United States. Although the distances from homes to hospitals vary with geography – people who live in rural areas travel farther than those who live in cities – in general most patients are admitted to a hospital close to where they live that provides an appropriate level of care. Data for all Dartmouth Atlas regional data reflect the experience of Medicare patients living in the region, regardless of where the care was actually delivered." - The Dartmouth Atlas of Health Care (Data By Region)PearlieMae's older sister, Alice, did live and use the services of a physician nearby her in North Carolina. Alice was able with family and community support to receive care at her home where she was able to succumb to her non-cancerous illness. The concern with cancer is the use of sufficient pain relieving medications. In this time and in this current atmosphere of drug abuse the concern for receiving medications that can and often are abused is more of a concern than insuring that patients have enough to "succumb" comfortably in their home. That's more speculation than the results of the research from the Dartmouth Atlas of Health Care.
