The impact of early palliative care interventions on the utilization of medical care resources for end-of-life patients

Abstract

Background Palliative care is gaining importance, particularly with the aging population. In Taiwan, the availability of palliative care has expanded, supported by reimbursement initiatives from the Taiwan National Health Insurance. The healthcare system in Taiwan is currently integrating more comprehensive palliative care payment benefit plans. However, incorporating palliative care services into the medical care of critically ill individuals nearing the end of life presents several challenges. This study aims to examine the impact of palliative care on the utilization of medical resources in end-of-life scenarios. Methods A total of 2,202 patients were included in this study. The primary diagnosis and intervention for palliative referral and consultation were based on the HNI code. Additionally, eight dependent indicators of medical resource utilization,30 days before death, were employed in this study. Results Hospice care for end-of-life patients was associated with less medical resource and aggressive care in the 30 days before death, including intensive care unit use (odds ratio [OR] = 0.468, 95% confidence interval [CI], 0.378–0.579, P < 0.001, cardiopulmonary resuscitation ([OR] = 0.247, 95% CI: 0.154–0.394, P < 0.001, endotracheal intubation ([OR] = 0.266, 95% CI: 0.191–0.372, P < 0.001, respiratory ventilator support ([OR] = 0.431, 95% CI: 0.348–0.533, P < 0.001) and blood transfusion ([OR] = 0.819, 95% CI: 0.667–1.005, P = 0.0555). Conclusion Patients at the end-of-life who received palliative care experienced a reduced incidence of aggressive medical interventions before death. These encompassed activities such as stays in the intensive care unit, cardiopulmonary resuscitation, endotracheal intubation, respiratory ventilator support, and blood transfusions. The utilization of medical resources varies among patients based on their specific diseases and comorbidities. Early intervention of palliative care or consultation, both for cancer and chronic disease patients, tends to result in less aggressive medical care interventions, including endotracheal intubation, respiratory ventilation, or even cardiopulmonary resuscitation in patients with severe illnesses.