scholarly journals Reply to Comment on: How U.S. Doctors Die: A Cohort Study of Healthcare Use at the End of Life

2017 ◽  
Vol 65 (8) ◽  
pp. 1887-1887 ◽  
Author(s):  
Stacy M. Fischer ◽  
Dan D. Matlock
Keyword(s):  
Cohort Study ◽  
End Of Life ◽  
Healthcare Use

scholarly journals How U.S. Doctors Die: A Cohort Study of Healthcare Use at the End of Life

2016 ◽  
Vol 64 (5) ◽  
pp. 1061-1067 ◽  
Author(s):  
Daniel D. Matlock ◽  
Traci E. Yamashita ◽  
Sung-Joon Min ◽  
Alexander K. Smith ◽  
Amy S. Kelley ◽  
...  
Keyword(s):  
Cohort Study ◽  
End Of Life ◽  
Healthcare Use

scholarly journals Understanding which people with dementia are at risk of inappropriate care and avoidable transitions to hospital near the end-of-life: a retrospective cohort study

2019 ◽  
Vol 48 (5) ◽  
pp. 672-679 ◽  
Author(s):  
Javiera Leniz ◽  
Irene J Higginson ◽  
Robert Stewart ◽  
Katherine E Sleeman
Keyword(s):  
Cohort Study ◽  
End Of Life ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Hospital Admissions ◽  
Care Home ◽  
Mental Health Provider ◽  
Healthcare Use ◽  
Hospital Data ◽  
People With Dementia

Abstract Background transitions between care settings near the end-of-life for people with dementia can be distressing, lead to physical and cognitive deterioration, and may be avoidable. Objective to investigate determinants of end-of-life hospital transitions, and association with healthcare use, among people with dementia. Design retrospective cohort study. Setting electronic records from a mental health provider in London, linked to national mortality and hospital data. Subjects people with dementia who died in 2007–2016. Methods end-of-life hospital transitions were defined as: multiple admissions in the last 90 days (early), or any admission in the last three days of life (late). Determinants were assessed using logistic regression. Results of 8,880 people, 1,421 (16.0%) had at least one end-of-life transition: 505 (5.7%) had early, 788 (8.9%) late, and 128 (1.5%) both types. Early transitions were associated with male gender (OR 1.33, 95% CI 1.11–1.59), age (>90 vs <75 years OR 0.69, 95% CI 0.49–0.97), physical illness (OR 1.52, 95% CI 1.20–1.94), depressed mood (OR 1.49, 95% CI 1.17–1.90), and deprivation (most vs least affluent quintile OR 0.58, 95% CI 0.37–0.90). Care home residence was associated with fewer early (OR 0.63, 95% CI 0.53 to 0.76) and late (OR 0.80, 95% CI 0.65 to 0.97) transitions. Early transitions were associated with more hospital admissions throughout the last year of life compared to those with late and no transitions (mean 4.56, 1.89, 1.60; P < 0.001). Conclusions in contrast to late transitions, early transitions are associated with higher healthcare use and characteristics that are predictable, indicating potential for prevention.

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 Healthcare use and costs in the last year of life: a national population data linkage study

2021 ◽  
pp. bmjspcare-2020-002708
Author(s):  
Katharina Diernberger ◽  
Xhyljeta Luta ◽  
Joanna Bowden ◽  
Marie Fallon ◽  
Joanne Droney ◽  
...  
Keyword(s):  
End Of Life ◽  
Secondary Care ◽  
Urban Areas ◽  
Data Linkage ◽  
Hospital Admissions ◽  
Community Support ◽  
Population Data ◽  
Linkage Study ◽  
Healthcare Use ◽  
Admission Rates

BackgroundPeople who are nearing the end of life are high users of healthcare. The cost to providers is high and the value of care is uncertain.ObjectivesTo describe the pattern, trajectory and drivers of secondary care use and cost by people in Scotland in their last year of life.MethodsRetrospective whole-population secondary care administrative data linkage study of Scottish decedents of 60 years and over between 2012 and 2017 (N=274 048).ResultsSecondary care use was high in the last year of life with a sharp rise in inpatient admissions in the last 3 months. The mean cost was £10 000. Cause of death was associated with differing patterns of healthcare use: dying of cancer was preceded by the greatest number of hospital admissions and dementia the least. Greater age was associated with lower admission rates and cost. There was higher resource use in the urban areas. No difference was observed by deprivation.ConclusionsHospitalisation near the end of life was least frequent for older people and those living rurally, although length of stay for both groups, when they were admitted, was longer. Research is required to understand if variation in hospitalisation is due to variation in the quantity or quality of end-of-life care available, varying community support, patient preferences or an inevitable consequence of disease-specific needs.

scholarly journals Assessing the utilization of radiotherapy near end of life at a Finnish University Hospital: a retrospective cohort study

2017 ◽  
Vol 56 (10) ◽  
pp. 1265-1271 ◽  
Author(s):  
Liisa K. Rautakorpi ◽  
Johanna M. Mäkelä ◽  
Fatemeh Seyednasrollah ◽  
Anna M. Hammais ◽  
Tarja Laitinen ◽  
...  
Keyword(s):  
Cohort Study ◽  
End Of Life ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
University Hospital
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