Hospitals vary markedly in the frequency and length of hospitalizations and intensive care unit (ICU) admissions and the number of specialists consulted for chronically ill Medicare beneficiaries during their last 6 months of life. The objective of our proposal is to explore this phenomenon using in-depth hospital case studies.

The goal is to identify provider and organizational norms that can be changed in high intensity hospitals to improve efficiency and patient-centeredness of treatment. The research design involves an interviewer and fieldworker engaging in 4 weeks of shadow observation and in-depth analysis of ICU cases based upon semi-structured interviews with the providers, managers, non-clinical staff, and patients or proxy decision makers involved.

We will use a mixture of qualitative content analysis of field-notes and interview transcripts, and quantitative analysis of hospital utilization and outcomes data and of provider, patient, and family survey data.