The association between varying levels of palliative care involvement on costs during terminal hospitalizations in Canada from 2012 to 2015

BMC Health Services Research

Sarina R. Isenberg¹  James Downar²  Peter G. Lawlor³  Peter Tanuseputro³  Amy T. Hsu⁴  Danial Qureshi⁴  Colleen Webber⁴  Peter May⁵  Kimberlyn McGrail⁶  Christopher Meaney⁷  Amna Husain⁸  Thomas J. Smith⁹  Hsien Seow^1,10  Julie Lachance^1,11  Kieran Quinn^1,12  Rob Fowler^1,13  Stephanie Saunders^1,14 

[1] Bruyère Research Institute, 43 Bruyère St, Office 264J-G, K1N 5C8, Ottawa, ON, Canada;Department of Family and Community Medicine, University of Toronto, Toronto, Canada;Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada;Department of Medicine, University of Ottawa, Ottawa, Canada;Bruyère Research Institute, 43 Bruyère St, Office 264J-G, K1N 5C8, Ottawa, ON, Canada;Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Canada;Bruyère Research Institute, 43 Bruyère St, Office 264J-G, K1N 5C8, Ottawa, ON, Canada;Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Canada;Ottawa Hospital Research Institute, Ottawa, Canada;Bruyère Research Institute, 43 Bruyère St, Office 264J-G, K1N 5C8, Ottawa, ON, Canada;Ottawa Hospital Research Institute, Ottawa, Canada;Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland;The Irish Longitudinal study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland;Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, Canada;Department of Family and Community Medicine, University of Toronto, Toronto, Canada;Department of Family and Community Medicine, University of Toronto, Toronto, Canada;Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Canada;Department of Medicine, Johns Hopkins Hospital and Health System, Baltimore, USA;Department of Oncology, Johns Hopkins Hospital and Health System, Baltimore, USA;Department of Oncology, McMaster University, Hamilton, Canada;End-of-Life Care Unit, Strategic Policy Branch, Health Canada, Ottawa, Canada;Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada;Department of Medicine, University of Toronto, Toronto, Canada;Department of Medicine, Division of Internal Medicine, Sinai Health, Toronto, Canada;Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada;Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada;Tory Trauma Program, Sunnybrook Hospital, Toronto, Canada;Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Canada;

关键词: Palliative care;    Acute care costs;    Terminal hospitalizations;    End of life;   

DOI  :  10.1186/s12913-021-06335-1

来源: Springer

【 摘 要 】

BackgroundInpatient palliative care is associated with lower inpatient costs; however, this has yet to be studied using a more nuanced, multi-tiered measure of inpatient palliative care and a national population-representative dataset. Using a population-based cohort of Canadians who died in hospital, our objectives were to: describe patients’ receipt of palliative care and active interventions in their terminal hospitalization; and examine the relationship between inpatient palliative care and hospitalization costs.MethodsRetrospective cohort study using data from the Discharge Abstract Database in Canada between fiscal years 2012 and 2015. The cohort were Canadian adults (age ≥ 18 years) who died in hospital between April 1st, 2012 and March 31st, 2015 (N = 250,640). The exposure was level of palliative care involvement defined as: medium-high, low, or no palliative care. The main measure was acute care costs calculated using resource intensity weights multiplied by the cost of standard hospital stay, represented in 2014 Canadian dollars (CAD). Descriptive statistics were represented as median (IQR), and n(%). We modelled cost as a function of palliative care using a gamma generalized estimating equation (GEE) model, accounting for clustering by hospital.ResultsThere were 250,640 adults who died in hospital. Mean age was 76 (SD 14), 47% were female. The most common comorbidities were: metastatic cancer (21%), heart failure (21%), and chronic obstructive pulmonary disease (16%). Of the decedents, 95,450 (38%) had no palliative care involvement, 98,849 (38%) received low involvement, and 60,341 (24%) received medium to high involvement. Controlling for age, sex, province and predicted hospital mortality risk at admission, the cost per day of a terminal hospitalization was: $1359 (95% CI 1323: 1397) (no involvement), $1175 (95% CI 1146: 1206) (low involvement), and $744 (95% CI 728: 760) (medium-high involvement).ConclusionsIncreased involvement of palliative care was associated with lower costs. Future research should explore whether this relationship holds for non-terminal hospitalizations, and whether palliative care in other settings impacts inpatient costs.

【 授权许可】

CC BY