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Resurrecting Treatment Histories of Dead Patients
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To the Editor: In their Special Communication,1 Dr Bach and colleagues argue that "look-back" studies of decedents produce biased inferences regarding treatment patterns and quality of care because patients who have their initial diagnosis of fatal illness during their last year are not a random sample of those with a disease and thus have systematically different durations of exposure to end-of-life costs and utilization.
However, additional considerations may make these retrospective study designs appropriate. Most Americans with serious, eventually fatal, chronic illnesses such as heart failure and chronic obstructive pulmonary disease live for several years before dying.2 In many cases, the timing of death is quite unpredictable even very close to death, because the events that precipitate dying may be sudden.3 One-year look-back studies of these decedents would not raise substantial problems of prediagnosis bias. Similarly, retrospective studies with appropriately shortened time frames could also mitigate that bias. Furthermore, if . . . [Full Text of this Article]
Amber E. Barnato, MD, MPH, MS
barnatoae@upmc.edu
Department of Medicine
University of Pittsburgh
Pittsburgh, Pa
Joanne Lynn, MD, MA, MS
RAND
Arlington,Va
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