Potentially Inappropriate End of Life Care and Healthcare Costs in the Last 30 Days of Life in Regions Providing Integrated Palliative Care in the Netherlands: A Registration-based Study.
Chantal F R Pereira, Anne-Floor Q Dijxhoorn, Berdine Koekoek, Monique van den Broek, Karin van der Steen, Marijanne Engel, Marjon van Rijn, Judith M Meijers, Jeroen Hasselaar, Agnes van der Heide, Bregje D Onwuteaka-Philipsen, Marieke H J van den Beuken-van Everdingen, Yvette M van der Linden, Manon S Boddaert, Patrick P T Jeurissen, Matthias A W Merkx, Natasja J H Raijmakers
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Abstract
Introduction: This study aimed to assess the effect of integrated palliative care (IPC) on potentially inappropriate end- of-life care and healthcare-costs in the last 30 days of life in the Netherlands.
Methods: Nationwide health-insurance claims data were used to assess potentially inappropriate end-of-life care (≥2 emergency room visits; ≥2 hospital admissions; >14 days hospitalization; chemotherapy; ICU admission; hospital death) and healthcare-costs in all deceased adults in IPC regions pre- and post- implementation and in those receiving IPC compared to a 1:2 matched control group.
Results: In regions providing IPC deceased adults (n = 37,468) received significantly less potentially inappropriate end-of-life care post-implementation compared to pre-implementation (26.5% vs 27.9%; p < 0.05). Deceased adults who received IPC (n = 210) also received significantly less potentially inappropriate end-of-life care compared to a matched control group (14.8% vs 28.3%; p < 0.05). Mean hospital costs significantly decreased for deceased adults who received IPC (€2,817), while mean costs increased for general practitioner services (€311) and home care (€1,632).
Discussion: These results highlight the importance of implementation of integrated palliative care and suitable payment. Further research in a larger sample is needed.
Conclusion: This study shows less potentially inappropriate end-of-life care and a shift in healthcare costs from hospital to general practitioner and home care with IPC.
简介：本研究旨在评估综合姑息关怀（IPC）对荷兰生命最后 30 天中潜在的不当临终关怀和医疗成本的影响：本研究旨在评估综合姑息关怀（IPC）对荷兰生命最后30天潜在的不恰当临终关怀和医疗成本的影响：方法：利用全国医疗保险理赔数据评估综合姑息治疗实施前后各地区所有已故成人的潜在不当临终关怀（≥2次急诊就诊；≥2次入院；>14天住院；化疗；入住重症监护室；住院死亡）和医疗成本，并将接受综合姑息治疗的成人与1:2匹配对照组进行比较：在提供IPC的地区，已故成人（n = 37,468）在实施IPC后接受的潜在不适当临终护理明显少于实施前（26.5% vs 27.9%; p < 0.05）。与匹配对照组相比，接受IPC治疗的已故成人（n = 210）所接受的潜在不适当临终护理也明显减少（14.8% vs 28.3%; p < 0.05）。接受IPC治疗的已故成人的平均住院费用明显降低（2817欧元），而全科医生服务（311欧元）和家庭护理（1632欧元）的平均费用则有所增加：这些结果凸显了实施综合姑息关怀和适当支付的重要性。结论：这项研究表明，潜在的不适当临终关怀减少了：这项研究表明，IPC 减少了潜在的不恰当临终关怀，医疗成本也从医院转移到全科医生和家庭护理。
期刊介绍：
Established in 2000, IJIC’s mission is to promote integrated care as a scientific discipline. IJIC’s primary purpose is to examine critically the policy and practice of integrated care and whether and how this has impacted on quality-of-care, user experiences, and cost-effectiveness.
The journal regularly publishes conference supplements and special themed editions. To find out more contact Managing Editor, Susan Royer.
The Journal is supported by the International Foundation for Integrated Care (IFIC).
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