New horizons (Baltimore, Md.)
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Healthcare reform continues to move forward, with the influence of managed care increasing in most areas of the United States. Strategies for cost containment are being considered to limit marginally beneficial health care, including futile-care policies, capitation, preset limits on health care, and guidelines for writing do-not-resuscitate (DNR) orders. Recent studies which attempted to improve communication between patients and physicians have failed to improve the quality of end-of-life care offered by healthcare providers. ⋯ Moreover, approximately 0.5% of all ICU care could be limited should DNR orders be written earlier in a patient's hospital or ICU stay. In addition, a shift from open-format ICUs to semiclosed units managed by qualified critical care physician directors would reduce the number of patients with futile or failed cardiopulmonary resuscitation, and increase the number of patients having care withheld or withdrawn after failed ICU therapy. Such a change would result in more substantial savings.