Health service use and costs in the last 6 months of life in elderly decedents with a history of cancer: a comprehensive analysis from a health payer perspective

Langton, Julia M; Reeve, Rebecca; Srasuebkul, Preeyaporn; Haas, Marion; Viney, Rosalie; Currow, David C.; Pearson, Sallie‐Anne

doi:10.1038/bjc.2016.75

Cited by 51 publications

(59 citation statements)

References 65 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is particularly important because hospitalisations account for the vast majority of end-of-life costs. 13 In this paper, we identified particular patient groups (e.g. cancer patients, those living in disadvantaged areas of NSW) who are more likely to use hospital services extensively at the end of life.…”

Section: Discussionmentioning

confidence: 99%

“…The fragmented nature of palliative care data holdings across hospital and community settings, and the lack of clinical information in MBS data (physician visits, community nursing) are limitations of our current data holdings. 10,13 Such data are vital to fully understanding the nature and extent of end-of-life care.…”

Section: Discussionmentioning

confidence: 99%

“…12,13 As the sole payer of health services for its clients, the DVA maintains custodianship of a variety of routine data collections, so that research using DVA data provides a whole-of-health system description of end-of-life care. However, it is limited to a subset of the population, representing a small percentage of Australians older than 65 years of age.…”

Section: 11mentioning

confidence: 99%

“…We used two previously described cohorts [10][11][12][13] , both based on health administrative data. To ensure that data were comparable across the two cohorts, our analysis was limited to people aged 65 years or older who died in NSW in 2007 (the 'population cohort') or in [2006][2007] (the 'DVA cohort'); 2007 is the most recent year for which information on cause of death was available to our research group.…”

Section: Study Samplesmentioning

confidence: 99%

“…A comparison of the datasets available for both cohorts is summarised in Table 1. Additional information about these linked datasets for the population cohort 10,11 and DVA cohort 12,13 has been published previously. …”

Section: Data Sources and Ethicsmentioning

confidence: 99%

See 4 more Smart Citations

Insights from linking routinely collected data across Australian health jurisdictions: a case study of end-of-life health service use

Langton

Goldsbury²,

Srasuebkul

et al. 2018

Public Health Res Pr

Self Cite

View full text Add to dashboard Cite

Objectives: The jurisdictional nature of routinely collected health data in Australia has created challenges for linking data across state/territory and federal government boundaries. This has impeded understanding of the interplay between service use across hospital and community care. Our objective was to demonstrate the value-add of cross-jurisdictional data using a case study of health service use and the factors associated with healthcare use towards the end of life.Study type: Retrospective cohort study using routinely collected health data. Methods:We used two decedent cohorts of people aged ≥65 years who died in New South Wales (NSW), Australia, in 2006 or 2007. The population cohort comprised the general NSW population linked to NSW data collections; the other cohort comprised Australian Government Department of Veterans' Affairs (DVA) clients (with full healthcare entitlements) linked to NSW and Commonwealth data. We compared information available on health services received during the last 6 months of life and ran multivariable analyses for both cohorts to demonstrate the added value of the Commonwealth data. Results:We included 37 567 decedents in the population cohort and 11 259 in the DVA cohort. Cancer was the cause of death for 27% of the NSW cohort and 22% of the DVA cohort; approximately 40% of decedents in each cohort had a cancer history. We summarise information on hospital services for both cohorts and examine community care (general practitioner consultations, specialist presentations, prescriptions dispensed) for the DVA cohort only. Multivariable analyses in the DVA cohort demonstrated that high rates of emergency department (ED) presentations and hospitalisation were associated with higher rates of use of all health services, including

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: 11mentioning

confidence: 99%

Section: Study Samplesmentioning

confidence: 99%

Section: Data Sources and Ethicsmentioning

confidence: 99%

See 3 more Smart Citations

Insights from linking routinely collected data across Australian health jurisdictions: a case study of end-of-life health service use

Langton

Goldsbury²,

Srasuebkul

et al. 2018

Public Health Res Pr

Self Cite

View full text Add to dashboard Cite

show abstract

Cancer patients as frequent attenders in emergency departments: A national cohort study

et al. 2018

View full text Add to dashboard Cite

BackgroundCancer patients contribute significantly to emergency department (ED) utilization. The objective of this study was to identify factors associated with patients becoming ED frequent attenders (FA) after a cancer‐related hospitalization.MethodsA retrospective cohort study was conducted using national administrative, billing, and death records of Singapore residents discharged alive from Singapore public hospitals from January 2012 to December 2015, with a primary discharge diagnosis of cancer. Patients with four or more ED visits within any 12‐month period after discharge from their index hospitalization were classified as FA. Time to FA distribution was estimated using the Kaplan‐Meier method, and factors associated with risk of FA were identified using multivariate Cox regression analyses.ResultsRecords for 47 235 patients were analyzed, of whom 2980 patients were FA within the study period. Age (<17 years, hazard ratio [HR] 2.92, 95% CI 2.28‐3.74; 75‐84 years, HR 1.29, 95% CI 1.16‐1.45; and ≥85 years, HR 1.71, 95% CI 1.45‐2.02, relative to age 55‐64), male gender (HR 1.26, 95% CI 1.16‐1.37), Charlson comorbidity index (HR 1.21, 95% CI 1.19‐1.23), and socioeconomic factors (Medifund use, HR 1.40, 95% CI 1.23‐1.59; housing subsidy type, HR 2.12, 95% CI 1.77‐2.54) were associated with increased risk of FA. Primary malignancies associated with FA included brain and spine (HR 2.51, 95% CI 1.67‐3.75), head and neck cancers (tongue, HR 2.05, 95% CI 1.27‐3.31; hypopharynx, HR 2.72, 95% CI 1.56‐4.74), lung (trachea and lung, HR 1.57, 95% CI 1.13‐2.18; pleural, HR 3.69, 95% CI 2.12‐6.34), upper gastrointestinal (stomach, HR 1.93, 95% CI 1.26‐2.74; esophagus, HR 4.13, 95% CI 2.78‐6.13), hepato‐pancreato‐biliary (liver, HR 1.42, 95% CI 1.01‐2.00, pancreas, HR 2.48, 95% CI 1.72‐3.59), and certain hematological malignancies (diffuse non‐Hodgkin's lymphoma, HR1.59, 95% CI 1.08‐2.33, lymphoid leukemia, HR 1.86, 95% CI 1.21‐2.86). Brain (HR 1.69, 95% CI 1.27‐2.26), lung (HR 1.31, 95% CI 1.01‐1.71), liver (HR 1.46, 95% CI 1.14‐1.89), and bone (HR 1.35, 95% CI 1.04‐1.76) metastases were also associated with FA.ConclusionThere are cancer‐specific factors contributing to ED frequent attendance. Additional resources should be allocated to support high‐risk groups and prevent unnecessary ED use.

show abstract

Describing settings of care in the last 100 days of life for cancer decedents: a population‐based descriptive study

et al. 2022

View full text Add to dashboard Cite

Background Few studies have described the settings cancer decedents spend their end‐of‐life stage, with none considering homecare specifically. We describe the different settings of care experienced in the last 100 days of life by individuals with cancer and how settings of care change as they approached death. Methods A retrospective cohort study from January 2013 to December 2017, of decedents whose primary cause of death was cancer, using linked population‐level health administrative datasets in Ontario, Canada. Results Decedents 125,755 were included in our cohort. The average age at death was 73, 46% were female, and 14% resided in rural regions. And 24% died of lung cancer, 7% breast, 7% colorectal, 7% pancreatic, 5% prostate, and 50% other cancers. In the last 100 days of life, decedents spent 25.9 days in institutions, 25.8 days receiving care in the community, and 48.3 days at home without any care. Individuals who died of lung and pancreatic cancers spent the most days at home without any care (52.1 and 52.6 days), while individuals who died of prostate and breast cancer spent the least days at home without any care (41.6 and 45.1 days). Regardless of cancer type, decedents spent fewer days at home and more days in institutions as they approached death, despite established patient preferences for an end‐of‐life experience at home. Conclusions In the last 100 days of life, cancer decedents spent most of their time in either institutions or at home without any care. Improving homecare services during the end‐of‐life may provide people dying of cancer with a preferred dying experience.

show abstract

Health service use and costs in the last 6 months of life in elderly decedents with a history of cancer: a comprehensive analysis from a health payer perspective

Cited by 51 publications

References 65 publications

Insights from linking routinely collected data across Australian health jurisdictions: a case study of end-of-life health service use

Insights from linking routinely collected data across Australian health jurisdictions: a case study of end-of-life health service use

Cancer patients as frequent attenders in emergency departments: A national cohort study

Describing settings of care in the last 100 days of life for cancer decedents: a population‐based descriptive study

Contact Info

Product

Resources

About