De-intensifying care for seniors: The next frontier in healthcare quality?

A new invited commentary in JAMA Internal Medicine by IHPI members Eve Kerr, M.D., M.P.H., and Timothy Hofer, M.D., M.Sc., says the evidence is growing rapidly that dialing back the intensity of treatment for older seniors with diabetes and other conditions needs to be a new area of focus for clinical care. 

Kerr and Hofer wrote in response to a new study in the same journal led by Mayo Clinic researchers, which showed that 20% of middle-aged patients with Type 2 diabetes were receiving intensive treatment that may be unnecessary. In those with multiple medical issues, this overtreatment could raise the risk of their blood sugar levels dipping dangerously low.

The commentary also cites research led by two other IHPI members -- Jeremy Sussman, M.D., M.Sc. and Tanner Caverly, M.D., M.P.H. -- published last fall that showed potential opportunities for scaling back treatment in Medicare participants with diabetes. 

"Balancing the medical profession’s focus on aggressively treating patients who are likely to benefit with an explicit consideration of when to deintensify treatments when they are no longer useful or are potentially harmful, and doing so in a manner that is respectful to the patient-physician relationship and promotes shared decision making, is the next frontier for improving care quality,"  Kerr and Hofer write in the new commentary. 

Kerr, Sussman and Caverly also wrote about the issue of dialing back treatment in some older patients last fall in The Conversation, a website for perspectives by academics on societal issues.