Survival of adult high-cost patients. Report of a follow-up study from nine acute-care hospitals.

To assess the degree to which high-cost illness is terminal illness, survival data were obtained on a random sample of 776 adult high-cost patients from nine acute-care hospitals in the San Francisco Bay area. Two years after discharge, at least 34% of high-cost patients had died. These patients accounted for 39% of the hospital charges incurred by the total group of patients studied. Among the factors significantly associated with death were a diagnosis of cancer (62% death), age older than 64 years (44% death), discharge from a medical (as opposed to surgical) service (42% death), and hospital bill of $10,000 and more (48% death). In-hospital and posthospital death rates varied greatly among the nine hospitals. The data suggest that large amounts of medical care are consumed by patients with unfavorable prognoses.