scholarly journals Early initiation of palliative care is associated with reduced late-life acute-hospital use: A population-based retrospective cohort study

2018 ◽  
Vol 33 (2) ◽  
pp. 150-159 ◽  
Author(s):  
Danial Qureshi ◽  
Peter Tanuseputro ◽  
Richard Perez ◽  
Greg R Pond ◽  
Hsien-Yeang Seow
Keyword(s):  
Palliative Care ◽  
Confidence Interval ◽  
Organ Failure ◽  
End Of Life ◽  
Acute Care ◽  
Odds Ratio ◽  
Population Based ◽  
Community Based ◽  
Early Palliative Care ◽  
Acute Care Settings

Background: Early palliative care can reduce end-of-life acute-care use, but findings are mainly limited to cancer populations receiving hospital interventions. Few studies describe how early versus late palliative care affects end-of-life service utilization. Aim: To investigate the association between early versus late palliative care (hospital/community-based) and acute-care use and other publicly funded services in the 2 weeks before death. Design: Retrospective population-based cohort study using linked administrative healthcare data. Setting/participants: Decedents (cancer, frailty, and organ failure) between 1 April 2010 and 31 December 2012 in Ontario, Canada. Initiation time before death (days): early (⩾60) and late (⩾15 and <60). ‘Acute-care settings’ included acute-hospital admissions with (‘palliative-acute-care’) and without palliative involvement (‘non-palliative-acute-care’). Results: We identified 230,921 decedents. Of them, 27% were early palliative care recipients and 13% were late; 45% of early recipients had a community-based initiation and 74% of late recipients had a hospital-based initiation. Compared to late recipients, fewer early recipients used palliative-acute care (42% vs 65%) with less days (mean days: 9.6 vs 12.0). Late recipients were more likely to use acute-care settings; this was further modified by disease: comparing late to early recipients, cancer decedents were nearly two times more likely to spend >1 week in acute-care settings (odds ratio = 1.84, 95% confidence interval: 1.83–1.85), frailty decedents were three times more likely (odds ratio = 3.04, 95% confidence interval: 3.01–3.07), and organ failure decedents were four times more likely (odds ratio = 4.04, 95% confidence interval: 4.02–4.06). Conclusion: Early palliative care was associated with improved end-of-life outcomes. Late initiations were associated with greater acute-care use, with the largest influence on organ failure and frailty decedents, suggesting potential opportunities for improvement.

scholarly journals Evaluating the impact of timing of initiation of community-based palliative care on use and cost of unplanned acute care services at the end of life: A study using linked hospital and community based provider service data

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Rachael Moorin ◽  
Cameron Wright ◽  
David Youens
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Data Collection ◽  
Length Of Stay ◽  
End Of Life ◽  
Acute Care ◽  
Community Based ◽  
Timing Of Initiation ◽  
The Impact ◽  
Care Costs

IntroductionExpected time to death is often used to determine eligibility to publicly funded community-based palliative care (CPC) because most acute care costs in the end-of-life period are incurred immediately prior death. We know CPC use reduces acute care costs but the impact of timing of initiation is unknown. Objectives and ApproachWe explored the association between timing of CPC initiation and unplanned hospital use, over the final year of life for Western Australian cancer decedents who died between 1/1/2001 and 31/12/2011 using linked Cancer Registry, Mortality System, Hospital Morbidity Data Collection, Emergency Department (ED) Data Collection and CPC records. The relationship between first-time use of CPC and unplanned hospitalisations and ED presentations was evaluated using multivariable negative binomial regression and Cragg-hurdle models. The exposure was month of CPC initiation (adjusted for intensity of use); outcomes were the rate, length of stay and cost of unplanned hospitalisations and emergency department presentations. ResultsOf the 28,331 decedents residing in the CPC catchment area, 16,439 (58%) accessed CPC, mostly (64%) in the last three months of life. Initiation of CPC prior to the last six months of life was associated with a lower mean number of unplanned hospitalisations in the last six months of life (1.4 versus 1.7 for initiation within six months of death); associated average costs were also lower ((AU$, 2012) 12,976 versus $13,959). While patients initiating CPC earlier showed a trend toward fewer hospital admissions, earlier initiation was associated with a higher cumulative and average length of stay. Indirect adjustment for admission complexity suggests that this may be due to more complicated indications. Conclusion/ImplicationsThis study provides more detail to guide policy around timing of access to CPC. Our results argue against restricting access to the final few months of life, as earlier initiation may result in fewer and lower the cost of unplanned hospitalisations and ED presentations at the very end of life.

Early referral to a palliative team improves end-of-life care among gynecological cancer patients: a retrospective, population-based study

2022 ◽  
pp. ijgc-2021-002898
Author(s):  
Torbjørn Paulsen ◽  
Heidi Liland ◽  
Tor Åge Myklebust ◽  
Kristina Lindemann
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
End Of Life Care ◽  
Gynecological Cancer ◽  
Population Based ◽  
Life Care ◽  
Early Palliative Care ◽  
Disease Trajectory ◽  
Norwegian Radium Hospital

ObjectiveTo assess end-of-life care among patients with gynecological cancer, and to describe the association between timing of palliative care referral and patterns of care.MethodsAll women with residence in Oslo, Norway, who died of gynecological cancer between January 1, 2015 and December 30, 2017 (36 months), were identified. Patients were primarily treated at the Norwegian Radium Hospital and clinical data on end-of-life care were retrospectively extracted from the medical records.ResultsWe identified 163 patients with median age 70.1 years at death (range 26–100) with the following diagnoses: ovarian (n=100), uterine (n=40), cervical (n=21), and vulvar cancer (n=2). 53 (33%) of patients died in a palliative care unit, 34 patients (21%) died in nursing homes without palliative care, and 48 (29%) patients died in hospital. Only 15 (9%) patients died at home. 25 (15%) patients received chemotherapy in the last 30 days before death, especially ovarian cancer patients (n=21, 21%). 103 patients (61%) were referred to a palliative team prior to death. Referral to a palliative team was associated with a significantly reduced risk of intensive care unit admission (OR 0.11, 95% CI 0.02 to 0.62) and higher likelihood of a structured end-of-life discussion (OR 2.91, 95% CI 1.03 to 8.25). Palliative care referral also seemed to be associated with other quality indicators of end-of-life care (less chemotherapy use, more home deaths).ConclusionsEnd-of-life care in patients with gynecological cancer suffers from underuse of palliative care. Chemotherapy is still commonly used towards end-of-life. Early palliative care referral in the disease trajectory may be an important step towards improved end-of-life care.

scholarly journals Association between high cost user status and end-of-life care in hospitalized patients: A national cohort study of patients who die in hospital

2021 ◽  
pp. 026921632110020
Author(s):  
Kieran L Quinn ◽  
Amy T Hsu ◽  
Christopher Meaney ◽  
Danial Qureshi ◽  
Peter Tanuseputro ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Acute Care ◽  
End Of Life Care ◽  
Major Surgery ◽  
Life Care ◽  
Healthcare Use ◽  
National Cohort ◽  
Acute Healthcare ◽  
Invasive Intervention

Background: Studies comparing end-of-life care between patients who are high cost users of the healthcare system compared to those who are not are lacking. Aim: The objective of this study was to describe and measure the association between high cost user status and several health services outcomes for all adults in Canada who died in acute care, compared to non-high cost users and those without prior healthcare use. Settings and participants: We used administrative data for all adults who died in hospital in Canada between 2011 and 2015 to measure the odds of admission to the intensive care unit (ICU), receipt of invasive interventions, major surgery, and receipt of palliative care during the hospitalization in which the patient died. High cost users were defined as those in the top 10% of acute healthcare costs in the year prior to a person’s hospitalization in which they died. Results: Among 252,648 people who died in hospital, 25,264 were high cost users (10%), 112,506 were non-high cost users (44.5%) and 114,878 had no prior acute care use (45.5%). After adjustment for age and sex, high cost user status was associated with a 14% increased odds of receiving an invasive intervention, a 15% increased odds of having major surgery, and an 8% lower odds of receiving palliative care compared to non-high cost users, but opposite when compared to patients without prior healthcare use. Conclusions: Many patients receive aggressive elements of end-of-life care during the hospitalization in which they die and a substantial number do not receive palliative care. Understanding how this care differs between those who were previously high- and non-high cost users may provide an opportunity to improve end of life care for whom better care planning and provision ought to be an equal priority.

scholarly journals Factors associated with parental traditional medicine use for children in Fagita Lekoma Woreda Northwest Ethiopia: A cross-sectional study

2020 ◽  
Vol 8 ◽  
pp. 205031212097800
Author(s):  
Damtew Asrat ◽  
Atsede Alle ◽  
Bekalu Kebede ◽  
Bekalu Dessie
Keyword(s):  
Confidence Interval ◽  
Traditional Medicine ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Cross Sectional Study ◽  
Medicine Use ◽  
Community Based ◽  
Cross Sectional ◽  
Traditional Medicines ◽  
Factors Associated

Background: Over the last 100 years, the development and mass production of chemically synthesized drugs have revolutionized health care in most parts of the world. However, large sections of the population in developing countries still depend on traditional medicines for their primary health care needs. More than 88% of Ethiopian parents use different forms of traditional medicine for their children. Therefore, this study aimed to determine factors associated with parental traditional medicine use for children in Fagita Lekoma Woreda. Method: Community-based cross-sectional study was conducted from 1 to 30 March 2019 in Fagita Lekoma Woreda. Data collection tool was a structured interviewer-administered questionnaire. Both descriptive and inferential statistics were used to present the data. Odds ratio and binary and multiple logistic regression analysis were used to measure the relationship between dependent and independent variables. Results: Among 858 participants, 71% of parents had used traditional medicine for their children within the last 12 months. Parents who cannot read and write (adjusted odds ratio = 6.42, 95% confidence interval = 2.1–19.7), parents with low monthly income (adjusted odds ratio = 4.38, 95% confidence interval = 1.58–12.1), and those who had accesses to traditional medicine (adjusted odds ratio = 2.21, 95% confidence interval = 1.23–3.98) were more likely to use traditional medicine for their children. Urban residents (adjusted odds ratio = 0.20, 95% confidence interval = 0.11–0.38) and members of community-based health insurance (adjusted odds ratio = 0.421, 95% confidence interval = 0.211–0.84) were less likely to use traditional medicine for their children. Conclusions: Our study revealed that the prevalence of traditional medicine remains high. Educational status, monthly income, residence, accessibility to traditional medicine, and being a member of community-based health insurance were predictors of potential traditional medicine use. Therefore, the integration of traditional medicine with modern medicine should be strengthened. Community education and further study on efficacy and safety of traditional medicines should be also given great attention.

scholarly journals P330 Current Practices at the End of Life in General Medicine Acute Care Settings in Canada

2016 ◽  
Vol 52 (6) ◽  
pp. e150
Author(s):  
Philippe Toupin ◽  
Natalia Novosedlik ◽  
Lisa Le ◽  
Camilla Zimmermann ◽  
Kirsten Wentlandt ◽  
...  
Keyword(s):  
End Of Life ◽  
Acute Care ◽  
General Medicine ◽  
Acute Care Settings ◽  
Current Practices

scholarly journals Improving End-of-Life Care: Palliative Care Embedded in an Oncology Clinic Specializing in Targeted and Immune-Based Therapies

2017 ◽  
Vol 13 (9) ◽  
pp. e729-e737 ◽  
Author(s):  
David J. Einstein ◽  
Susan DeSanto-Madeya ◽  
Matthew Gregas ◽  
Jessica Lynch ◽  
David F. McDermott ◽  
...  
Keyword(s):  
Palliative Care ◽  
Usual Care ◽  
End Of Life ◽  
Odds Ratio ◽  
Care Clinic ◽  
Usual Practice ◽  
Embedded Model ◽  
Enrollment Rates ◽  
Oncology Practice ◽  
The Impact

Purpose: Patients with advanced cancer benefit from early involvement of palliative care. The ideal method of palliative care integration remains to be determined, as does its effectiveness for patients treated with targeted and immune-based therapies. Materials and Methods: We studied the impact of an embedded palliative care team that saw patients in an academic oncology clinic specializing in targeted and immune-based therapies. Patients seen on a specific day accessed the embedded model, on the basis of automatic criteria; patients seen other days could be referred to a separate palliative care clinic (usual care). We abstracted data from the medical records of 114 patients who died during the 3 years after this model’s implementation. Results: Compared with usual care (n = 88), patients with access to the embedded model (n = 26) encountered palliative care as outpatients more often ( P = .003) and earlier (mean, 231 v 109 days before death; P < .001). Hospice enrollment rates were similar ( P = .303), but duration was doubled (mean, 57 v 25 days; P = .006), and enrollment > 7 days before death—a core Quality Oncology Practice Initiative metric—was higher in the embedded model (odds ratio, 5.60; P = .034). Place of death ( P = .505) and end-of-life chemotherapy (odds ratio, 0.361; P = .204) did not differ between the two arms. Conclusion: A model of embedded and automatically triggered palliative care among patients treated exclusively with targeted and immune-based therapies was associated with significant improvements in use and timing of palliative care and hospice, compared with usual practice.

Is specialized palliative cancer care associated with use of antineoplastic treatment at the end of life? A population-based cohort study

2018 ◽  
Vol 32 (9) ◽  
pp. 1509-1517 ◽  
Author(s):  
Kirstine Skov Benthien ◽  
Mathilde Adsersen ◽  
Morten Aagaard Petersen ◽  
Eva Soelberg Vadstrup ◽  
Per Sjøgren ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
End Of Life ◽  
Female Gender ◽  
Population Based ◽  
Hospital Units ◽  
Hematological Cancers ◽  
Specialized Palliative Care ◽  
Antineoplastic Treatment ◽  
Breast And Prostate Cancer

Background: The use of chemotherapy in the last 14 days of life should be as low as possible. Aim: To study the factors related to the use of chemotherapy in the last 14 days of life and the factors related to concurrent antineoplastic treatment and specialized palliative care. Design: This was a population-based cohort study. The data were collected from the Danish Register of Causes of Death, the Danish National Patient Register, and the Danish Palliative Care Database. Analyses were descriptive and multivariate logistic regression. Setting/participants: Cancer decedents between 2010 and 2013 in the Capital Region of Denmark. Results: During the study period, 17,246 individuals died of cancer and 33% received specialized palliative care. In the last 14 days of life, 4.2% received chemotherapy. Younger patients and patients with hematological cancers were more likely to receive chemotherapy in the last 14 days of life. Receiving specialized palliative care was associated with a lower risk of receiving chemotherapy in the last 14 days of life—odds ratio 0.15 for hospices and 0.53 for palliative hospital units. A total of 8% of the population received concurrent antineoplastic treatment and specialized palliative care. Female gender, younger age, and breast and prostate cancer were significantly associated with this concurrent model. Conclusion: Overall, the incidence of antineoplastic treatment in the last 14 days of life was low compared to other studies. Patients in specialized palliative care had a reduced risk of receiving chemotherapy at the end of life.

Sign in / Sign up

Export Citation Format

Share Document