The Hospice Information System and its association with the congruence between the preferred and actual place of death

Abstract

Objective:A Hospice Information System (HIS) developed in eastern Taiwan in 2012 aimed to improve the quality of hospice care through an integrated system that provided telemetry-based vital sign records, online 24/7 consultations, online video interviews, and online health educations. The purpose of this study was to explore the congruence between the preferred and actual place of death (POD) among patients who received HIS services.Materials and Methods:A retrospective study was performed from January 2012 to August 2016. Data from patients enrolled in the HIS who died during this period were included. Data on basic characteristics and the actual and preferred POD were obtained from the HIS database. The primary outcome was the congruence between the preferred and actual POD. Secondary outcomes were comparisons between patients who did and did not achieve their preferred POD. Further comparisons between patients who did and did not achieve home death were also performed.Results:In total, we enrolled 481 patients who received HIS services and died. Of them, 444 (92.3%) died at their preferred POD. Patients who preferred an inpatient hospice as their POD had higher achievement rate than those who wanted a home death. High-intensity HIS utilization was associated with a higher likelihood of home death than low-intensity HIS utilization. Patients living in areas distant from the medical center had lower achievement of home death than those living in local areas.Conclusions:This study suggested that patients enrolled in the HIS had high congruence between the actual and preferred POD.

Bioethics and Palliative Care in Primary Health Care

“…The World Health Organization (WHO) defines PC as "assistance promoted by a multidisciplinary team that aims to improve the quality of life of patients and their families in the face of a life-threatening disease, through prevention and relief of suffering, early identification, impeccable assessment and treatment of pain and other physical, social, psychological and spiritual symptoms" ( [13], p. 83). PC measures seek to guarantee the patient's quality of life to the detriment of prolonged life [2,14].…”

“…Meeting patient preferences continues to be the major concern in PC quality. For these preferences to be met, medical support and the involvement of the patients and their family in decision-making are essential [2].…”

“…It is known that home PC measures are related to higher chances of meeting these preferences [2], thus highlighting the importance of PHC in this process. In a study [1], PHC health professionals reported the desire to prioritize the patients' preferences; however, they did not know when and how to have end-of-life conversations with them.…”

“…Lack of access to home palliative care is still a problem in several countries. It may result in non-compliance with the patients' preferences on care and place of death [2]. It is also known that, despite advances, access to PC measures is still greater among cancer patients than among patients affected by other chronic conditions [32].…”

“…The preferred place to die among people throughout the world is their home; however, many still die in hospitals, with at least one admission in the last year of life [1][2][3].…”