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Iwata H, Matsushima M, Watanabe T, Sugiyama Y, Yokobayashi K, Son D, Satoi Y, Yoshida E, Satake S, Hinata Y, Fujinuma Y. The need for home care physicians in Japan - 2020 to 2060. BMC Health Serv Res 2020; 20:752. [PMID: 32799898 PMCID: PMC7429680 DOI: 10.1186/s12913-020-05635-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 08/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background Japan faces the most elderly society in the world, and the Japanese government has launched an unprecedented health plan to reinforce home care medicine and increase the number of home care physicians, which means that an understanding of future needs for geriatric home care is vital. However, little is known about the future need for home care physicians. We attempted to estimate the basic need for home care physicians from 2020 to 2060. Methods Our estimation is based on modification of major health work force analysis methods using previously reported official data. Two models were developed to estimate the necessary number of full-time equivalent (FTE) home care physicians: one based on home care patient mortality, the other using physician-to-patient ratio, working with estimated numbers of home and nursing home deaths from 2020 to 2060. Moreover, the final process considered and adjusted for future changes in the proportion of patients dying at home. Lastly, we converted estimated FTE physicians to an estimated head count. Results Results were concordant between our two models. In every instance, there was overlap of high- and low-estimations between the mortality method and the physician-to-patient method, and the estimates show highly similar patterns. Furthermore, our estimation is supported by the current number of physicians, which was calculated using a different method. Approximately 1.7 times (1.6 by head count) the current number of FTE home care physicians will be needed in Japan in the late 2030’s, peaking at 33,500 FTE (71,500 head count). However, the need for home care physicians is anticipated to begin decreasing by 2040. Conclusion The results indicate that the importance of home care physicians will rise with the growing elderly population, and that improvements in home care could partially suppress future need for physicians. After the late 2030’s, the supply can be reduced gradually, accounting for the decreasing total number of deaths after 2040. In order to provide sufficient home care and terminal care at home, increasing the number of home care physicians is indispensable. However, the unregulated supply of home care physicians will require careful attention in the future.
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Affiliation(s)
- Hiroyoshi Iwata
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105- 8461, Japan.
| | - Masato Matsushima
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105- 8461, Japan
| | - Takamasa Watanabe
- Kita-adachi Seikyo Clinic, Tokyo Hokuto Health Cooperative, Tokyo, Japan
| | - Yoshifumi Sugiyama
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105- 8461, Japan
| | | | - Daisuke Son
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshinao Satoi
- Kuji Clinic, Japanese Health and Welfare Co-operative Federation, Kawasaki, Japan
| | - Eriko Yoshida
- Kawasaki-Kyodo Hospital, Japanese Health and Welfare Co-operative Federation, Kawasaki, Japan
| | - Sumiko Satake
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105- 8461, Japan.,Department of Fundamental Nursing, The Jikei University School of Nursing, Tokyo, Japan
| | - Yuki Hinata
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105- 8461, Japan
| | - Yasuki Fujinuma
- Centre for Family Medicine Development, Japanese Health and Welfare Co-operative, Tokyo, Japan
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D’Angelo D, Di Nitto M, Giannarelli D, Croci I, Latina R, Marchetti A, Magnani C, Mastroianni C, Piredda M, Artico M, De Marinis MG. Inequity in palliative care service full utilisation among patients with advanced cancer: a retrospective Cohort study. Acta Oncol 2020; 59:620-627. [PMID: 32148138 DOI: 10.1080/0284186x.2020.1736335] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Advanced cancer patients often die in hospital after receiving needless, aggressive treatment. Although palliative care improves symptom management, barriers to accessing palliative care services affect its utilisation, and such disparities challenge the equitable provision of palliative care. This study aimed to identify which factors are associated with inequitable palliative care service utilisation among advanced cancer patients by applying the Andersen Behavioural Model of Health Services Use.Material and methods: This was a retrospective cohort study using administrative healthcare data. A total of 13,656 patients residing in the Lazio region of Italy, who died of an advanced cancer-related cause-either in hospital or in a specialised palliative care facility-during the period of 2012-2016 were included in the study. Potential predictors of specialised palliative service utilisation were explored by grouping the following factors: predisposing factors (i.e., individuals' characteristics), enabling factors (i.e., systemic/structural factors) and need factors (i.e., type/severity of illness).Results: The logistic hierarchical regression showed that older patients (odds ratio [OR] = 1.45; <0.0001) of Caucasian ethnicity (OR = 4.17; 0.02), with a solid tumour (OR = 1.87; <0.0001) and with a longer survival time (OR = 2.09; <0.0001) were more likely to be enrolled in a palliative care service. Patients who lived farther from a specialised palliative care facility (OR = 0.13; <0.0001) and in an urban area (OR = 0.58; <0.0001) were less likely to be enrolled.Conclusion: This study found that socio-demographic (age, ethnicity), clinical (type of tumour, survival time) and organisational (area of residence, distance from service) factors affect the utilisation of specialised palliative care services. The fact that service utilisation is not only a function of patients' needs but also of other aspects demonstrates the presence of inequity in access to palliative care among advanced cancer patients.
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Affiliation(s)
| | - Marco Di Nitto
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma, Italy
| | - Diana Giannarelli
- Department of Biostatistical Unit, IRCCS-Regina Elena National Cancer Institute, Roma, Italy
| | - Ileana Croci
- IRCCS Ospedale Pediatrico “Bambino Gesù”, Roma, Italy
| | - Roberto Latina
- Department of Nursing Science and Midwifery, Sapienza University, Roma, Italy
| | - Anna Marchetti
- Department of Research Unit Nursing Science, Campus Bio-Medico di Roma University, Roma, Italy
| | - Caterina Magnani
- Local Health Authority “Roma 1”, Borgo Santo Spirito 3, Roma, Italy
| | | | - Michela Piredda
- Department of Research Unit Nursing Science, Campus Bio-Medico di Roma University, Roma, Italy
| | - Marco Artico
- Department of Palliative Care and Pain Therapy Unit, Azienda ULSS n.4 Veneto Orientale, Roma, Italy
| | - Maria Grazia De Marinis
- Department of Research Unit Nursing Science, Campus Bio-Medico di Roma University, Roma, Italy
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Kalseth J, Halvorsen T. Relationship of place of death with care capacity and accessibility: a multilevel population study of system effects on place of death in Norway. BMC Health Serv Res 2020; 20:454. [PMID: 32448201 PMCID: PMC7245889 DOI: 10.1186/s12913-020-05283-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While the majority of deaths in high-income countries currently occur within institutional settings such as hospitals and nursing homes, there is considerable variation in the pattern of place of death. The place of death is known to impact many relevant considerations about death and dying, such as the quality of the dying process, family involvement in care, health services design and health policy, as well as public versus private costs of end-of-life care. The objective of this study was to analyse how the availability and capacity of publicly financed home-based and institutional care resources are related to place of death in Norway. METHODS This study utilized a dataset covering all deaths in Norway in the years 2003-2011, contrasting three places of death, namely hospital, nursing home and home. The analysis was performed using a multilevel multinomial logistic regression model to estimate the probability of each outcome while considering the hierarchical nature of factors affecting the place of death. The analysis utilized variation in health system variables at the local community and hospital district levels. The analysis was based on data from two public sources: the Norwegian Cause of Death Registry and Statistics Norway. RESULTS Hospital accessibility, in terms of short travel time and hospital bed capacity, was positively associated with the likelihood of hospital death. Higher capacity of nursing home beds increased the likelihood of nursing home death, and higher capacity of home care increased the likelihood of home death. Contrasting three alternative places of death uncovered a pattern of service interactions, wherein hospital and home care resources together served as an alternative to end-of-life care in nursing homes. CONCLUSIONS Norway has a low proportion of home deaths compared with other countries. The proportion of home deaths varies between local communities. Increasing the availability of home care services is likely to enable more people to die at home, if that is what they prefer.
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Affiliation(s)
- Jorid Kalseth
- Department of Health Research, SINTEF Digital, P.O. Box 4760, Sluppen, NO-7465, Trondheim, Norway.
| | - Thomas Halvorsen
- Department of Health Research, SINTEF Digital, P.O. Box 4760, Sluppen, NO-7465, Trondheim, Norway
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Luo L, Du W, Chong S, Ji H, Glasgow N. Patterns of comorbidities in hospitalised cancer survivors for palliative care and associated in-hospital mortality risk: A latent class analysis of a statewide all-inclusive inpatient data. Palliat Med 2019; 33:1272-1281. [PMID: 31296123 PMCID: PMC6899435 DOI: 10.1177/0269216319860705] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND At the end of life, cancer survivors often experience exacerbations of complex comorbidities requiring acute hospital care. Few studies consider comorbidity patterns in cancer survivors receiving palliative care. AIM To identify patterns of comorbidities in cancer patients receiving palliative care and factors associated with in-hospital mortality risk. DESIGN, SETTING/PARTICIPANTS New South Wales Admitted Patient Data Collection data were used for this retrospective cohort study with 47,265 cancer patients receiving palliative care during the period financial year 2001-2013. A latent class analysis was used to identify complex comorbidity patterns. A regression mixture model was used to identify risk factors in relation to in-hospital mortality in different latent classes. RESULTS Five comorbidity patterns were identified: 'multiple comorbidities and symptoms' (comprising 9.1% of the study population), 'more symptoms' (27.1%), 'few comorbidities' (39.4%), 'genitourinary and infection' (8.7%), and 'circulatory and endocrine' (15.6%). In-hospital mortality was the highest for 'few comorbidities' group and the lowest for 'more symptoms' group. Severe comorbidities were associated with elevated mortality in patients from 'multiple comorbidities and symptoms', 'more symptoms', and 'genitourinary and infection' groups. Intensive care was associated with a 37% increased risk of in-hospital deaths in those presenting with more 'multiple comorbidities and symptoms', but with a 22% risk reduction in those presenting with 'more symptoms'. CONCLUSION Identification of comorbidity patterns and risk factors for in-hospital deaths in cancer patients provides an avenue to further develop appropriate palliative care strategies aimed at improving outcomes in cancer survivors.
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Affiliation(s)
- Lan Luo
- Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Wei Du
- Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Shanley Chong
- South Western Sydney Local Health District and University of New South Wales, Sydney, NSW, Australia
| | - Huibo Ji
- Health Economics and Modelling Branch, Department of Health, Canberra, ACT, Australia
| | - Nicholas Glasgow
- Research School of Population Health, Australian National University, Canberra, ACT, Australia
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Maubach N, Batten M, Jones S, Chen J, Scholz B, Davis A, Bromley J, Burke B, Tan R, Hurwitz M, Rodgers H, Mitchell I. End‐of‐life care in an Australian acute hospital: a retrospective observational study. Intern Med J 2019; 49:1400-1405. [DOI: 10.1111/imj.14305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/18/2019] [Accepted: 03/19/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Ninya Maubach
- Medical SchoolThe Australian National University Canberra Australian Capital Territory Australia
| | - Monique Batten
- Medical SchoolThe Australian National University Canberra Australian Capital Territory Australia
| | - Scott Jones
- Medical SchoolThe Australian National University Canberra Australian Capital Territory Australia
| | - Judy Chen
- Medical SchoolThe Australian National University Canberra Australian Capital Territory Australia
| | - Brett Scholz
- Medical SchoolThe Australian National University Canberra Australian Capital Territory Australia
| | - Alison Davis
- Medical SchoolThe Australian National University Canberra Australian Capital Territory Australia
- The Canberra Hospital, ACT Health Canberra Australian Capital Territory Australia
| | - Jonathan Bromley
- Medical SchoolThe Australian National University Canberra Australian Capital Territory Australia
- The Canberra Hospital, ACT Health Canberra Australian Capital Territory Australia
| | - Brandon Burke
- Medical SchoolThe Australian National University Canberra Australian Capital Territory Australia
- The Canberra Hospital, ACT Health Canberra Australian Capital Territory Australia
| | - Ren Tan
- The Canberra Hospital, ACT Health Canberra Australian Capital Territory Australia
| | - Mark Hurwitz
- Medical SchoolThe Australian National University Canberra Australian Capital Territory Australia
- The Canberra Hospital, ACT Health Canberra Australian Capital Territory Australia
| | - Helen Rodgers
- The Canberra Hospital, ACT Health Canberra Australian Capital Territory Australia
| | - Imogen Mitchell
- Medical SchoolThe Australian National University Canberra Australian Capital Territory Australia
- The Canberra Hospital, ACT Health Canberra Australian Capital Territory Australia
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Neergaard MA, Brunoe AH, Skorstengaard MH, Nielsen MK. What socio-economic factors determine place of death for people with life-limiting illness? A systematic review and appraisal of methodological rigour. Palliat Med 2019; 33:900-925. [PMID: 31187687 DOI: 10.1177/0269216319847089] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Socio-economic factors play important roles in place of death. However, up-to-date knowledge on socio-economic determinants for place of death is warranted including analysis of collinearity between socio-economic determinants. AIM To examine associations between socio-economic determinants (social class, deprivation level in area of residence, income, education, occupation, urbanisation) and place of death among adult patients with life-limiting illnesses. Furthermore, to describe how these factors are operationalised and examined for collinearity. DESIGN A systematic review was performed (PROSPERO, record: CRD42018091218) and quality was assessed using the Newcastle-Ottawa Scale. DATA SOURCES A comprehensive search of PubMed, Embase, CINAHL, Scopus and PsycINFO was conducted for studies published from 1 January 2008 until the date of the search (23 March 2018) in English or Scandinavian languages. RESULTS Of the 1599 unique citations identified, 34 studies were eligible. Dying at home was to a high degree associated with better financial situation and living in rural areas. Furthermore, hospital death was associated with a high level of deprivation in the area of residence and being employed. Regarding educational level, we found mixed and inconclusive results. CONCLUSION Inequalities concerning place of death were found, and attention towards socio-economic inequality concerning place of death is necessary, especially in patients with a poor financial status, patients living in deprived and metropolitan areas and patients who are employed. Furthermore, we found a low degree of assessment for collinearity and adjustment of socio-economic variables. These issues should be considered in planning of future studies of socio-economic determinants for place of death.
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Turner V, Flemming K. Socioeconomic factors affecting access to preferred place of death: A qualitative evidence synthesis. Palliat Med 2019; 33:607-617. [PMID: 30848703 DOI: 10.1177/0269216319835146] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Existing quantitative evidence suggests that at a population level, socioeconomic factors affect access to preferred place of death. However, the influence of individual and contextual socioeconomic factors on preferred place of death are less well understood. AIM To systematically synthesise the existing qualitative evidence for socioeconomic factors affecting access to preferred place of death in the United Kingdom. DESIGN A thematic synthesis of qualitative research. DATA SOURCES Cochrane Library, MEDLINE, Embase, CINAHL, ASSIA, Scopus and PsycINFO databases were searched from inception to May 2018. RESULTS A total of 13 articles, reporting on 12 studies, were included in the synthesis. Two overarching themes were identified: 'Human factors' representing support networks, interactions between people and decision-making and 'Environmental factors', which included issues around locations and resources. Few studies directly referenced socioeconomic deprivation. The main factor affecting access to preferred place of death was social support; people with fewer informal carers were less likely to die in their preferred location. Other key findings included fluidity around the concept of home and variability in preferred place of death itself, particularly in response to crises. CONCLUSION There is limited UK-based qualitative research on socioeconomic factors affecting preferred place of death. Further qualitative research is needed to explore the barriers and facilitators of access to preferred place of death in socioeconomically deprived UK communities. In practice, there needs to be more widespread discussion and documentation of preferred place of death while also recognising these preferences may change as death nears or in times of crisis.
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Affiliation(s)
| | - Kate Flemming
- Department of Health Sciences, University of York, York, UK
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8
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Davies JM, Sleeman KE, Leniz J, Wilson R, Higginson IJ, Verne J, Maddocks M, Murtagh FEM. Socioeconomic position and use of healthcare in the last year of life: A systematic review and meta-analysis. PLoS Med 2019; 16:e1002782. [PMID: 31013279 PMCID: PMC6478269 DOI: 10.1371/journal.pmed.1002782] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 03/14/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Low socioeconomic position (SEP) is recognized as a risk factor for worse health outcomes. How socioeconomic factors influence end-of-life care, and the magnitude of their effect, is not understood. This review aimed to synthesise and quantify the associations between measures of SEP and use of healthcare in the last year of life. METHODS AND FINDINGS MEDLINE, EMBASE, PsycINFO, CINAHL, and ASSIA databases were searched without language restrictions from inception to 1 February 2019. We included empirical observational studies from high-income countries reporting an association between SEP (e.g., income, education, occupation, private medical insurance status, housing tenure, housing quality, or area-based deprivation) and place of death, plus use of acute care, specialist and nonspecialist end-of-life care, advance care planning, and quality of care in the last year of life. Methodological quality was evaluated using the Newcastle-Ottawa Quality Assessment Scale (NOS). The overall strength and direction of associations was summarised, and where sufficient comparable data were available, adjusted odds ratios (ORs) were pooled and dose-response meta-regression performed. A total of 209 studies were included (mean NOS quality score of 4.8); 112 high- to medium-quality observational studies were used in the meta-synthesis and meta-analysis (53.5% from North America, 31.0% from Europe, 8.5% from Australia, and 7.0% from Asia). Compared to people living in the least deprived neighbourhoods, people living in the most deprived neighbourhoods were more likely to die in hospital versus home (OR 1.30, 95% CI 1.23-1.38, p < 0.001), to receive acute hospital-based care in the last 3 months of life (OR 1.16, 95% CI 1.08-1.25, p < 0.001), and to not receive specialist palliative care (OR 1.13, 95% CI 1.07-1.19, p < 0.001). For every quintile increase in area deprivation, hospital versus home death was more likely (OR 1.07, 95% CI 1.05-1.08, p < 0.001), and not receiving specialist palliative care was more likely (OR 1.03, 95% CI 1.02-1.05, p < 0.001). Compared to the most educated (qualifications or years of education completed), the least educated people were more likely to not receive specialist palliative care (OR 1.26, 95% CI 1.07-1.49, p = 0.005). The observational nature of the studies included and the focus on high-income countries limit the conclusions of this review. CONCLUSIONS In high-income countries, low SEP is a risk factor for hospital death as well as other indicators of potentially poor-quality end-of-life care, with evidence of a dose response indicating that inequality persists across the social stratum. These findings should stimulate widespread efforts to reduce socioeconomic inequality towards the end of life.
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Affiliation(s)
- Joanna M. Davies
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
| | - Katherine E. Sleeman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
| | - Javiera Leniz
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
| | - Rebecca Wilson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
| | - Irene J. Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
| | - Julia Verne
- Health Intelligence, Public Health England, Bristol, United Kingdom
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
| | - Fliss E. M. Murtagh
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
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9
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Wilson DM, Shen Y, Birch S. Who Are High Users of Hospitals in Canada? Findings From a Population-Based Study. Can J Nurs Res 2019; 51:245-254. [PMID: 30845831 DOI: 10.1177/0844562119833584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Dying people and older people have often been thought of as high users of hospitals, but current population-based evidence is needed to confirm or refute this claim. Purpose Quantitative population-based study designed to identify and describe hospital patients who are high users. Methods Data for all 2014–2015 Canadian hospital patients (excluding Quebec) were analyzed to identify and describe high users through descriptive-comparative and regression analysis tests. Results Only a small proportion of patients are high users in relation to multiple admissions or 30+ inpatient days of care, and with considerable diversity among them and relatively few of these advanced in age or dying in hospital. Conclusions Relatively few patients are high users of hospitals. These people are most often under age 65, so they have the potential to be ill and high users for many years. Flagging would enable individualized care planning to reduce illness exacerbations or slow disease progression and address other risk factors for long or repeat hospitalizations.
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Affiliation(s)
- Donna M Wilson
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.,Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Faculty of Education & Health Sciences, University of Limerick, Limerick, Ireland
| | - Ye Shen
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Stephen Birch
- Centre for the Business and Economics of Health, University of Queensland, Brisbane, Australia
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Polt G, Weixler D, Bauer N. [A retrospective study about the influence of an emergency information form on the place of death of palliative care patients]. Wien Med Wochenschr 2019; 169:356-363. [PMID: 30725441 DOI: 10.1007/s10354-019-0681-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 01/02/2019] [Indexed: 11/27/2022]
Abstract
In palliative medicine planning in advance is important for critical care situations. It is highly significant to make useful and by the patient and his relatives desired decisions. These concern transport in a situation of crisis and the venue of death (either death at home or transfer to a hospital).In this study the effect of a new Emergency Information Form about the place of death was examined. The used Emergency Information Form enabled the patient to express a wish on transfer in the case of crisis in advance and communicate this wish to the Emergency system.A total of 858 patients, taken care of by the mobile palliative-team Hartberg/Weiz/Vorau in the period from 2010 to 2015, were included in the study. The Intervention group-the patients for whom an Emergency Information Form was established-counted 38 patients. Data analysis was retrospective, pseudo anonymized and external.The 4 most important results were:1) The Emergency Information Form increased the probability for the intervention group to die at home (intervention group: 72.2%, controll group 1: 53.0%, controll group 2: 56.6%).2) Important in this change was, that the opinion of the patients was considered. The decision made in the Emergency Information Form correlated with a high significance (p = 0.01) with the actual place of death.3) Furthermore, it came clear that the Emergency Information Form was a useful tool to handle the utilization of special facilities. Within the intervention group young patients (with a lot of symptoms) died in a special facility more often than old patients. These, rather geriatric people, were mostly brought to a general hospital.4) There was no significant relation between the duration of care and the probability that an Emergency Information Form was established (p = 0.63). However, there was a high significance between the number of home visits and the probability that an Emergency Information Form was written (p = 0.02).Due to the fact that there was a small intervention group restricted to only one palliative team further studies could help to make clear advises for palliative teams regarding scope, duration and frequency of home-visits. Thus the term "care continuity" could be concretized in the guidelines.The study brought forward that numerous (and short) contacts with the patient were more convenient than less but long home-visits in order to fulfil the patients wish concerning his place of death.
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Affiliation(s)
- Günter Polt
- LKH Hartberg, Rotkreuzplatz 2, 8230, Hartberg, Österreich.
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Cabañero-Martínez MJ, Nolasco A, Melchor I, Fernández-Alcántara M, Cabrero-García J. Place of death and associated factors: a population-based study using death certificate data. Eur J Public Health 2019; 29:608-615. [DOI: 10.1093/eurpub/cky267] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Although studies suggest that most people prefer to die at home, not enough is known about place of death patterns by cause of death considering sociodemographic factors. The objective of this study was to determine the place of death in the population and to analyze the sociodemographic variables and causes of death associated with home as the place of death.
Methods
Cross-sectional population-based study. All death certificate data on the residents in Spain aged 15 or over who died in Spain between 2012 and 2015 were included. We employed multinomial logistic regression to explore the relation between place of death, sociodemographic variables and cause of death classified according to the International Classification of Diseases, 10th revision, and to conditions needing palliative care.
Results
Over half of all deaths occurred in hospital (57.4%), representing double the frequency of deaths that occurred at home. All the sociodemographic variables (sex, educational level, urbanization level, marital status, age and country of birth) were associated with place of death, although age presented the strongest association. Cause of death was the main predictor with heart disease, neurodegenerative disease, Alzheimer’s disease, dementia and senility accounting for the highest percentages of home deaths.
Conclusions
Most people die in hospital. Cause of death presented a stronger association with place of death than sociodemographic variables; of these latter, age, urbanization level and marital status were the main predictors. These results will prove useful in planning end-of-life care that is more closely tailored to people’s circumstances and needs.
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Affiliation(s)
- María José Cabañero-Martínez
- Departamento de Enfermería, Universidad de Alicante, Alicante, España
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, España
| | - Andreu Nolasco
- Unidad Mixta de Investigación para el Análisis de las Desigualdades en Salud y la Mortalidad FISABIO-UA, Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública, e Historia de la Ciencia, Universidad de Alicante, Alicante, España
| | - Inmaculada Melchor
- Registro de Mortalidad de la Comunitat Valenciana, Servicio de Estudios Epidemiológicos y Estadísticas Sanitarias, Dirección General de Salud Pública, Conselleria de Sanitat Universal i Salut Pública, Generalitat Valenciana, Valenciana, España
- Unidad Mixta de Investigación Para el Análisis de las Desigualdades en Salud y la Mortalidad FISABIO-UA, Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública, e Historia de la Ciencia, Universidad de Alicante, Alicante, España
| | - Manuel Fernández-Alcántara
- Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC-UGR), Universidad de Granada, Granada, España
- Departamento de Psicología de la Salud, Universidad de Alicante (UA), Alicante, España
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Lim CY, Park JY, Kim DY, Yoo KD, Kim HJ, Kim Y, Shin SJ. Terminal lucidity in the teaching hospital setting. DEATH STUDIES 2018; 44:285-291. [PMID: 30513269 DOI: 10.1080/07481187.2018.1541943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 09/27/2018] [Accepted: 10/02/2018] [Indexed: 06/09/2023]
Abstract
Terminal lucidity is an unpredictable end-of-life experience that has invaluable implications in preparation for death. We retrospectively evaluated terminal lucidity at a university teaching hospital. Of 338 deaths that occurred during the study period (187 in the ICU and 151 in general wards), terminal lucidity was identified in 6 cases in general wards. Periods of lucidity ranged from several hours to 4 days. After experiencing terminal lucidity, half of the patients died within a week, and the remainder died within 9 days. More attention should be directed toward understanding terminal lucidity to improve end-of-life care in a meaningful way.
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Affiliation(s)
- Chi-Yeon Lim
- Clinical Trial Center, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, Republic of Korea
| | - Jae Yoon Park
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, Republic of Korea
| | - Do Yeun Kim
- Department of Hematology and Medical Oncology, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, Republic of Korea
| | - Kyung Don Yoo
- Department of Internal Medicine Dongguk University School of Medicine, Gyeongju, Republic of Korea
| | - Hyo Jin Kim
- Department of Internal Medicine Dongguk University School of Medicine, Gyeongju, Republic of Korea
| | - Yunmi Kim
- Department of Internal Medicine Dongguk University School of Medicine, Gyeongju, Republic of Korea
| | - Sung Joon Shin
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, Republic of Korea
- W Maurice Young Center for Applied Ethics, University of British Columbia, Vancouver, Canada
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13
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The Location of Death and Dying Across Canada: A Study Illustrating the Socio-Political Context of Death and Dying. SOCIETIES 2018. [DOI: 10.3390/soc8040112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Concern has existed for many years about the extensive use of hospitals by dying persons. In recent years, however, a potential shift out of hospital has been noticed in a number of developed countries, including Canada. In Canada, where high hospital occupancy rates and corresponding long waits and waitlists for hospital care are major socio-political issues, it is important to know if this shift has continued or if hospitalized death and dying remains predominant across Canada. Methods: Recent individual-anonymous population-level inpatient Canadian hospital data were analyzed to answer two questions: (1) what proportion of deaths in provinces and territories across Canada are occurring in hospital now? and (2) who is dying in hospital now? Results: In 2014–2015, 43.9% of all deaths in Canada (excluding Quebec) occurred in hospital. However, considerable cross-Canada differences in end-of-life hospital utilization were found. Some cross-Canada differences in hospital decedents were also noted, although most were older, male, and they died during a relatively short hospital stay after being admitted from their homes and through the emergency department after arriving by ambulance. Conclusion: Over half of all deaths in Canada are occurring outside of hospital now. Cross-Canada hospital utilization and inpatient decedent differences highlight opportunities for enhanced end-of-life care service planning and policy advancements.
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14
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Overbeek A, Van den Block L, Korfage IJ, Penders YWH, van der Heide A, Rietjens JAC. Admissions to inpatient care facilities in the last year of life of community-dwelling older people in Europe. Eur J Public Health 2018; 27:814-821. [PMID: 28957486 DOI: 10.1093/eurpub/ckx105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background In the last year of life, many older people rather avoid admissions to inpatient care facilities. We describe and compare such admissions in the last year of life of 5092 community-dwelling older people in 15 European countries (+Israel). Methods Proxy-respondents of the older people, who participated in the longitudinal SHARE study, reported on admissions to inpatient care facilities (hospital, nursing home or hospice) during the last year of their life. Multivariable regression analyses assessed associations between hospitalizations and personal/contextual characteristics. Results The proportion of people who had been admitted at least once to an inpatient care facility in the last year of life ranged from 54% (France) to 76% (Austria, Israel, Slovenia). Admissions mostly concerned hospitalizations. Multivariable analyses showed that especially Austrians, Israelis and Poles had higher chances of being hospitalized. Further, hospitalizations were more likely for those being ill for 6 months or more (OR:1.67, CI:1.39-2.01), and less likely for persons aged 80+ (OR:0.54, CI:0.39-0.74; compared with 48-65 years), females (OR:0.74, CI:0.63-0.89) and those dying of cardiovascular diseases (OR:0.66, CI:0.51-0.86; compared with those dying of cancer). Conclusions Although healthcare policies increasingly stress the importance that people reside at home as long as possible, admissions to inpatient care facilities in the last year of life are relatively common across all countries. Furthermore, we found a striking variation concerning the proportion of admissions across countries which cannot only be explained by patient needs. It suggests that such admissions are at least partly driven by system-level or cultural factors.
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Affiliation(s)
- Anouk Overbeek
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ida J Korfage
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Yolanda W H Penders
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
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15
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Kelfve S, Wastesson J, Fors S, Johnell K, Morin L. Is the level of education associated with transitions between care settings in older adults near the end of life? A nationwide, retrospective cohort study. Palliat Med 2018; 32:366-375. [PMID: 28952874 DOI: 10.1177/0269216317726249] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND End-of-life transitions between care settings can be burdensome for older adults and their relatives. AIM To analyze the association between the level of education of older adults and their likelihood to experience care transitions during the final months before death. DESIGN Nationwide, retrospective cohort study using register data. SETTING/PARTICIPANTS Older adults (⩾65 years) who died in Sweden in 2013 ( n = 75,722). Place of death was the primary outcome. Institutionalization and multiple hospital admissions during the final months of life were defined as secondary outcomes. The decedents' level of education (primary, secondary, or tertiary education) was considered as the main exposure. Multivariable analyses were stratified by living arrangement and adjusted for sex, age at time of death, illness trajectory, and number of chronic diseases. RESULTS Among community-dwellers, older adults with tertiary education were more likely to die in hospitals than those with primary education (55.6% vs 49.9%; odds ratio (OR) = 1.21, 95% confidence interval (CI) = 1.14-1.28), but less likely to be institutionalized during the final month before death (OR = 0.83, 95% CI = 0.76-0.91). Decedents with higher education had greater odds of remaining hospitalized continuously during their final 2 weeks of life (OR = 1.12, 95% CI = 1.02-1.22). Among older adults living in nursing homes, we found no association between the decedents' level of education and their likelihood to be hospitalized or to die in hospitals. CONCLUSION Compared with those who completed only primary education, individuals with higher educational attainment were more likely to live at home until the end of life, but also more likely to be hospitalized and die in hospitals.
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Affiliation(s)
- Susanne Kelfve
- 1 Division Ageing and Social Change, Department of Social and Welfare Studies, Linköping University, Linköping, Sweden.,2 Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Jonas Wastesson
- 2 Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Stefan Fors
- 2 Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,3 Centre for Health Equity Studies, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Kristina Johnell
- 2 Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Lucas Morin
- 2 Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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16
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Lind S, Wallin L, Brytting T, Fürst C, Sandberg J. Implementation of national palliative care guidelines in Swedish acute care hospitals: A qualitative content analysis of stakeholders’ perceptions. Health Policy 2017; 121:1194-1201. [DOI: 10.1016/j.healthpol.2017.09.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/11/2017] [Accepted: 09/14/2017] [Indexed: 12/25/2022]
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17
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Chisumpa VH, Odimegwu CO, De Wet N. Adult mortality in sub-saharan Africa, Zambia: Where do adults die? SSM Popul Health 2017; 3:227-235. [PMID: 29349220 PMCID: PMC5769069 DOI: 10.1016/j.ssmph.2017.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 01/30/2017] [Accepted: 02/01/2017] [Indexed: 11/23/2022] Open
Abstract
Place of death remains an issue of growing interest and debate among scholars as an indicator of quality of end-of-life care in developed countries. In sub-Saharan Africa, however, variations in place of death may suggest inequalities in access to and the utilization of health care services that should be addressed by public health interventions. Limited research exists on factors associated with place of death in sub-Saharan Africa. The study examines factors associated with the place of death among Zambian adults aged 15–59 years using the 2010–2012 sample vital registration with verbal autopsy survey (SAVVY) data, descriptive statistics and multivariate logistic regression analysis. Results show that more than half of the adult deaths occurred in a health facility and two-fifths died at home. Higher educational attainment, urban versus rural residence, and being of female gender were significant predictors of the place of death. Improvement in educational attainment and investment in rural health facilities and the health care system as a whole may improve access and utilization of health services among adults. We examined factors associated with place of death among adults aged 15–59 in Zambia. Health facility remains the common place of death in Zambia followed by the deceased's home. High proportion of adults still dying at home indicates a lack of access to and the utilization of health care services. Educational attainment, sex, and urban-rural residence were strong predictors of the place of death. Variations in place of death by population background characteristics among adult decedents may suggest inequalities in access and utilization of health services.
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Affiliation(s)
- Vesper H Chisumpa
- Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia.,Demography and Population Studies Programme, School of Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Clifford O Odimegwu
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicole De Wet
- Demography and Population Studies Programme, School of Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
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18
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Nakanishi M, Niimura J, Nishida A. Factors associated with end-of-life by home-visit nursing-care providers in Japan. Geriatr Gerontol Int 2016; 17:991-998. [DOI: 10.1111/ggi.12822] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 02/06/2016] [Accepted: 04/07/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Miharu Nakanishi
- Mental Health and Nursing Research Team, Department of Psychiatry and Behavioral Science; Tokyo Metropolitan Institute of Medical Science; Tokyo Japan
| | - Junko Niimura
- Mental Health and Nursing Research Team, Department of Psychiatry and Behavioral Science; Tokyo Metropolitan Institute of Medical Science; Tokyo Japan
| | - Atsushi Nishida
- Mental Health Promotion Project, Department of Psychiatry and Behavioral Science; Tokyo Metropolitan Institute of Medical Science; Tokyo Japan
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19
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Affiliation(s)
- YongJoo Rhee
- Department of Health Sciences, Dongduk Women’s University, Seoul, Korea
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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20
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Pivodic L, Pardon K, Miccinesi G, Vega Alonso T, Moreels S, Donker GA, Arrieta E, Onwuteaka-Philipsen BD, Deliens L, Van den Block L. Hospitalisations at the end of life in four European countries: a population-based study via epidemiological surveillance networks. J Epidemiol Community Health 2015; 70:430-6. [DOI: 10.1136/jech-2015-206073] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 10/30/2015] [Indexed: 11/04/2022]
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21
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Leysen B, Van den Eynden B, Gielen B, Bastiaens H, Wens J. Implementation of a Care Pathway for Primary Palliative Care in 5 research clusters in Belgium: quasi-experimental study protocol and innovations in data collection (pro-SPINOZA). BMC Palliat Care 2015; 14:46. [PMID: 26416574 PMCID: PMC4585994 DOI: 10.1186/s12904-015-0043-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 09/14/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Starting with early identification of palliative care patients by general practitioners (GPs), the Care Pathway for Primary Palliative Care (CPPPC) is believed to help primary health care workers to deliver patient- and family-centered care in the last year of life. The care pathway has been pilot-tested, and will now be implemented in 5 Belgian regions: 2 Dutch-speaking regions, 2 French-speaking regions and the bilingual capital region of Brussels. The overall aim of the CPPPC is to provide better quality of primary palliative care, and in the end to reduce the hospital death rate. The aim of this article is to describe the quantitative design and innovative data collection strategy used in the evaluation of this complex intervention. METHODS/DESIGN A quasi-experimental stepped wedge cluster design is set up with the 5 regions being 5 non-randomized clusters. The primary outcome is reduced hospital death rate per GPs' patient population. Secondary outcomes are increased death at home and health care consumption patterns suggesting high quality palliative care. Per research cluster, GPs will be recruited via convenience sampling. These GPs -volunteering to be involved will recruit people with reduced life expectancy and their informal care givers. Health care consumption data in the last year of life, available for all deceased people having lived in the research clusters in the study period, will be used for comparison between patient populations of participating GPs and patient populations of non-participating GPs. Description of baseline characteristics of participating GPs and patients and monitoring of the level of involvement by GPs, patients and informal care givers will happen through regular, privacy-secured web-surveys. Web-survey data and health consumption data are linked in a secure way, respecting Belgian privacy laws. DISCUSSION To evaluate this complex intervention, a quasi-experimental stepped wedge cluster design has been set up. Context characteristics and involvement level of participants are important parameters in evaluating complex interventions. It is possible to securely link survey data with health consumption data. By appealing to IT solutions we hope to be able to partly reduce respondent burden, a known problem in palliative care research. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02266069.
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Affiliation(s)
- Bert Leysen
- Department of Primary and Interdisciplinary Care, University of Antwerp, Universiteitsplein 1, Antwerp, Wilrijk, 2610, Belgium.
| | - Bart Van den Eynden
- Department of Primary and Interdisciplinary Care, University of Antwerp, Universiteitsplein 1, Antwerp, Wilrijk, 2610, Belgium.
- Centre for Palliative Care Sint-Camillus, Oosterveldlaan 24, Antwerp, Wilrijk, 2610, Belgium.
| | - Birgit Gielen
- InterMutualistic Agency, Tervurenlaan, 188/A, Brussels, 1150, Belgium.
| | - Hilde Bastiaens
- Department of Primary and Interdisciplinary Care, University of Antwerp, Universiteitsplein 1, Antwerp, Wilrijk, 2610, Belgium.
| | - Johan Wens
- Department of Primary and Interdisciplinary Care, University of Antwerp, Universiteitsplein 1, Antwerp, Wilrijk, 2610, Belgium.
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22
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Håkanson C, Öhlén J, Morin L, Cohen J. A population-level study of place of death and associated factors in Sweden. Scand J Public Health 2015; 43:744-51. [DOI: 10.1177/1403494815595774] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2015] [Indexed: 11/17/2022]
Abstract
Aims: The aims of this study were to examine, on a population level, where people die in Sweden, and to investigate associations between place of death and underlying cause of death, socioeconomic and environmental characteristics, with a particular interest in people dying from life-limiting conditions typically in need of palliative care. Methods: This population-level study is based on death certificate data for all deceased individuals in Sweden in 2012, with a registered place of death ( n=83,712). Multivariable logistic regression was performed to investigate associations between place of death and individual, socioeconomic and environmental characteristics. Results: The results show that, in 2012, 42.1% of all deaths occurred in hospitals, 17.8% occurred at home and 38.1% in nursing home facilities. Individuals dying of conditions indicative of potential palliative care needs were less likely to die in hospital than those dying of other conditions (OR = 0.73; 95% CI = 0.70–0.77). Living at home in urban areas was associated with higher likelihood of dying in hospital or in a nursing home (OR = 1.04 and 1.09 respectively). Educational attainment and marital status were found to be somewhat associated with the place of death. Conclusions: The majority of deaths in Sweden occur in institutional settings, with comparatively larger proportions of nursing home deaths than most countries. Associations between place of death and other variables point to inequalities in availability and/or utilization of health services at the end of life.
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Affiliation(s)
- Cecilia Håkanson
- Palliative Research Centre and Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden
- Department of Neurobiology, Care science and Society, Karolinska Institutet, Huddinge, Sweden
| | - Joakim Öhlén
- Palliative Research Centre and Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden
- Institute of Health and Care Sciences, The Sahlgrenska Academy and University of Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Lucas Morin
- Department of Neurobiology, Care science and Society, Karolinska Institutet, Huddinge, Sweden
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
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Morin L, Johnell K, Aubry R. Variation in the place of death among nursing home residents in France. Age Ageing 2015; 44:415-21. [PMID: 25605581 DOI: 10.1093/ageing/afu197] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 09/24/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES recent studies have reported that hospitals have become a common place of death for nursing home residents. This study aimed to (i) measure variations in the proportion of in-hospital deaths across regions after adjustment for facility-level characteristics and (ii) identify environmental risk factors that might explain these variations in France. DESIGN a cross-sectional retrospective survey was conducted in 2013. SETTING AND PARTICIPANTS coordinating physicians in 3,705 nursing homes in France. MEASUREMENTS a regression model was used to construct risk-adjusted rates of in-hospital deaths considering the facilities' characteristics. At the regional level, the outcome was defined as the difference between the observed rate of in-hospital deaths and the expected risk-adjusted rate. Values exceeding zero indicated rates that exceeded the national predicted rate of in-hospital deaths and thus highlighted regions in which the risk-adjusted probability for nursing home residents to die in a hospital was greater than average. RESULTS among 70,119 nursing home decedents, 25.4% (n = 17,789) died in hospitals. The characteristics of the facilities had a significant influence on the proportion of in-hospital deaths among the nursing home decedents. However, after adjustment for these facility-level risk factors, the proportion of nursing homes that reported worse-than-average outcomes showed significant variation (range 26.0-79.6%). At the regional level, both the rate of acute hospital beds and the rate of general practitioners were found to be strongly correlated with the probability of reporting worse-than-average outcomes (P < 0.001). CONCLUSION our study demonstrates the existence of major differences across regions in France and highlights the need for targeted interventions regarding end-of-life care in nursing home facilities.
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Affiliation(s)
- Lucas Morin
- French National Observatory on End-of-Life Care, Paris, France Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Kristina Johnell
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Régis Aubry
- University Hospital of Besancon, Besançon, France
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Verhofstede R, Smets T, Cohen J, Costantini M, Van Den Noortgate N, Deliens L. Improving end-of-life care in acute geriatric hospital wards using the Care Programme for the Last Days of Life: study protocol for a phase 3 cluster randomized controlled trial. BMC Geriatr 2015; 15:13. [PMID: 25887959 PMCID: PMC4340777 DOI: 10.1186/s12877-015-0010-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 02/03/2015] [Indexed: 11/18/2022] Open
Abstract
Background The Care Programme for the Last Days of Life has been developed to improve the quality of end-of-life care in acute geriatric hospital wards. The programme is based on existing end-of-life care programmes but modeled to the acute geriatric care setting. There is a lack of evidence of the effectiveness of end-of-life care programmes and the effects that may be achieved in patients dying in an acute geriatric hospital setting are unknown. The aim of this paper is to describe the research protocol of a cluster randomized controlled trial to evaluate the effects of the Care Programme for the Last Days of Life. Methods and design A cluster randomized controlled trial will be conducted. Ten hospitals with one or more acute geriatric wards will conduct a one-year baseline assessment during which care will be provided as usual. For each patient dying in the ward, a questionnaire will be filled in by a nurse, a physician and a family carer. At the end of the baseline assessment hospitals will be randomized to receive intervention (implementation of the Care Programme) or no intervention. Subsequently, the Care Programme will be implemented in the intervention hospitals over a six-month period. A one-year post-intervention assessment will be performed immediately after the baseline assessment in the control hospitals and after the implementation period in the intervention hospitals. Primary outcomes are symptom frequency and symptom burden of patients in the last 48 hours of life. Discussion This will be the first cluster randomized controlled trial to evaluate the effect of the Care Programme for the Last Days of Life for the acute geriatric hospital setting. The results will enable us to evaluate whether implementation of the Care Programme has positive effects on end-of-life care during the last days of life in this patient population and which components of the Care Programme contribute to improving the quality of end-of-life care. Trial registration ClinicalTrials.gov Identifier: NCT01890239. Registered June 24th, 2013.
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Affiliation(s)
- Rebecca Verhofstede
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.
| | - Tinne Smets
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.
| | - Massimo Costantini
- Palliative Care Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy.
| | | | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium. .,Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium.
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