Healthcare trajectories and costs in the last year of life: a retrospective primary care and hospital analysis

Luta, Xhyljeta; Diernberger, Katharina; Bowden, Joanna; Droney, Joanne; Howdon, Daniel; Schmidlin, Kurt; Rodwin, Victor G.; Hall, Peter; Marti, Joachim

doi:10.1136/bmjspcare-2020-002630

Cited by 29 publications

(27 citation statements)

References 26 publications

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“…20 The present study was conducted in parallel with a study of end-of-life healthcare trajectories and costs for decedents in England during 2010-2017. 21 We describe the rationale for separating the two studies in the Discussion section.…”

Section: What Is Their Significance?mentioning

confidence: 99%

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

Diernberger

Luta

Bowden

et al. 2021

BMJ Support Palliat Care

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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.

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Section: What Is Their Significance?mentioning

confidence: 99%

“…Our parallel study of decedents in England was able to draw on primary care data, although only for a particular cohort. 21…”

Section: Main Findingsmentioning

confidence: 99%

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

Diernberger

Luta

Bowden

et al. 2021

BMJ Support Palliat Care

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“…The costs for general healthcare in the elderly has been found to increase with proximity to death, and has been associated with sex [ 2 , 3 , 4 ], place of living [ 1 , 4 , 5 ], SES [ 6 ] or age, as described [ 2 , 4 , 7 , 8 ]. In the present evaluation, we assessed costs for dental services provided to the very old by one statutory insurer in Germany.…”

Section: Discussionmentioning

confidence: 99%

“…Compared with medical costs throughout most of the life course, end-of-life costs have been found to be high, mainly driven by repeated inpatient (hospital) admissions [ 1 ]. Costs have been associated with aspects like sex (with ambiguous data finding either male or female individuals experiencing higher medical costs towards the end of life) [ 2 , 3 , 4 ], the place of living (with costs being higher in more urban and affluent areas) [ 1 , 4 , 5 ], socio-economic status (SES, with costs being higher in more affluent high-SES groups) [ 6 ] or age (with end-of-life costs being consistently higher in younger-dying individuals than those dying older) [ 2 , 4 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Costs for Statutorily Insured Dental Services in Older Germans 2012–2017

Krasowski

Krois

Paris

et al. 2021

IJERPH

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Objectives: We assessed the costs of dental services in statutorily insured, very old (geriatric) Germans. Methods: A comprehensive sample of very old (≥75 years) people insured at a large Northeastern statutory insurer was followed over 6 years (2012–2017). We assessed dental services costs for: (1) examination, assessments and advice, (2) operative, (3) surgical, (4) prosthetic, (5) periodontal, (6) preventive and (7) outreach services. Association of utilization with: (1) sex, (2) age, (3) region, (4) social hardship status, (5) International Disease Classification (ICD-10) diagnoses and (6) Diagnoses Related Groups (DRGs) was explored. Results: 404,610 individuals with a mean (standard deviation, SD) age 81.9 (5.4 years) were followed, 173,733 did not survive follow-up. Total mean costs were 129.61 (310.97) euro per capita; the highest costs were for prosthetic (54.40, SD 242.89 euro) and operative services (28.40, SD 68.38 euro), examination/advice (21.15, SD 28.77 euro), prevention (13.31, SD 49.79 euro), surgery (5.91, SD 23.91 euro), outreach (4.81, SD 28.56 euro) and periodontal services (1.64, SD 7.39 euro). The introduction of new fee items for outreach and preventive services between 2012 and 2017 was reflected in costs. Total costs decreased with increasing age, and this was also found for all service blocks except outreach and preventive services. Costs were higher in those with social hardship status, and in Berlin than Brandenburg and Mecklenburg-Western Pomerania. Certain general health conditions were associated with increased or decreased costs. Conclusions: Costs were associated with sex, social hardship status, place of living and general health conditions. Clinical significance: Dental services costs for the elderly in Germany are unequally distributed and, up to a certain age or health status, generated by invasive interventions mainly. Policy makers should incentivize preventive services earlier on and aim to distribute expenses more equally.

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“…33 34 Thus, several studies have tried to examine whether the concept of end-of-life illness trajectories can be ascertained in real-life data. [35][36][37][38][39][40][41] Teno et al, Lunney et al and Stolz et al conducted studies measuring functional decline at the end of life, and all concluded that the underlying illness causing death was following the pattern of illness trajectories as suggested by Glaser and Strauss. 11 35-38 Contrary to this, in 2007, Gott et al examined illness trajectories of physical function experienced by patients with heart failure prior to death but discovered no typical heart failure trajectory for most of the patients included.…”

Section: Open Accessmentioning

confidence: 99%

Healthcare utilisation trajectories in patients dying from chronic obstructive pulmonary disease, heart failure or cancer: a nationwide register-based cohort study

et al. 2021

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ObjectivesTo investigate illness trajectories as reflected by healthcare utilisation, including hospital and intensive care unit admissions, consultations in general practice and home care provision, before death comparing people dying from chronic obstructive pulmonary disease (COPD), heart failure and cancer.DesignNationwide register-based cohort study.SettingData on all hospital admissions, including intensive care unit admissions, consultations in general practice and home care provision were obtained from nationwide Danish registries.ParticipantsAll adult decedents in Denmark dying from COPD, heart failure or cancer between 2006 and 2016.Outcome measuresFor each day within 5 years before death, we computed a daily prevalence proportion (PP) of being admitted to hospital or consulting a general practitioner. For each day within 6 months before death, we computed PPs of being admitted to intensive care or receiving home care. The PPs were plotted and compared by regression analyses adjusting for age, gender, comorbidity level, marital/cohabitation status, municipality and income level.ResultsAmong 1 74 086 patients dying from COPD (n=22 648), heart failure (n=11 498) or cancer (n=139 940), the PPs of being admitted to hospital or consulting a general practitioner showed similar steady progression and steep increase in the last year of life for all patient populations. The PP of being admitted to intensive care showed modest increase during the last 6 months of life, accelerating in the last month, for all patient populations. For patients with COPD and heart failure, the PP of receiving home care remained stable during the last 6 months of life but increased steadily for patients with cancer.ConclusionWe found limited differences in healthcare resource utilisation at the end of life for people with COPD, heart failure or cancer, indicating comparable illness trajectories.This supports the need to reconsider efforts in achieving equal access to palliative care interventions, which is still mainly offered to patients with cancer.

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Healthcare trajectories and costs in the last year of life: a retrospective primary care and hospital analysis

Cited by 29 publications

References 26 publications

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

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

Costs for Statutorily Insured Dental Services in Older Germans 2012–2017

Healthcare utilisation trajectories in patients dying from chronic obstructive pulmonary disease, heart failure or cancer: a nationwide register-based cohort study

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