Transitions between health care settings in the final three months of life in four EU countries

Block, Lieve Van den; Pivodic, Lara; Pardon, Koen; Donker, Gé; Miccinesi, Guido; Moreels, Sarah; Alonso, Tomás Vega; Deliens, Luc; Onwuteaka-Philipsen, Bregje D.

doi:10.1093/eurpub/ckv039

Cited by 59 publications

(72 citation statements)

References 39 publications

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“…In the SENTI-MELC Study, only 38% of the decedents had no transition in the last three months of life [33]. Our results are also consistent with a recently published international study, in which data were gathered retrospectively by general practitioners networks [3]; more than one in two patients experienced at least one transition in the last three months and 1 in 10 patients in the last three days of life. Compared to Spain, Italy and Belgium, patients in the Netherlands were transferred less often at the end-of-life, which might be due to the importance of primary palliative care in this latter country [3].…”

Section: Discussionsupporting

confidence: 90%

“…Many efforts are undertaken in Switzerland to enable older and/or chronically ill patients to stay home longer. However, as shown in previous foreign studies, one of the consequences might be an increased need for hospitalisations at the end-of-life [3,4]. On the one hand, hospitalisations might turn out to be necessary when patients become more dependent, as dying at home usually requires formal as well as informal care; dying in a hospital was almost four times more likely for those who only received informal care, in contrast to those who received combined formal and informal care [5].…”

Section: Introductionmentioning

confidence: 97%

“…Likewise, having an infection was associated with terminal hospitalisation, whereby home-to-hospital was found to be the most frequent trajectory in the Netherlands [6]. According to van den Block and colleagues [3], however, final transition to hospital was frequently due to curative or life-prolonging reasons.…”

Section: Introductionmentioning

confidence: 99%

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Health Care Utilisation and Transitions between Health Care Settings in the Last 6 Months of Life in Switzerland

Bähler

Signorell²,

Reich³

2016

PLoS ONE

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BackgroundMany efforts are undertaken in Switzerland to enable older and/or chronically ill patients to stay home longer at the end-of-life. One of the consequences might be an increased need for hospitalisations at the end-of-life, which goes along with burdensome transitions for patients and higher health care costs for the society.AimWe aimed to examine the health care utilisation in the last six months of life, including transitions between health care settings, in a Swiss adult population.MethodsThe study population consisted of 11'310 decedents of 2014 who were insured at the Helsana Group, the leading health insurance in Switzerland. Descriptive statistics were used to analyse the health care utilisation by age group, taking into account individual and regional factors. Zero-inflated Poisson regression model was used to predict the number of transitions.ResultsMean age was 78.1 in men and 83.8 in women. In the last six months of life, 94.7% of the decedents had at least one consultation; 61.6% were hospitalised at least once, with a mean length of stay of 28.3 days; and nursing home stays were seen in 47.4% of the decedents. Over the same time period, 64.5% were transferred at least once, and 12.9% experienced at least one burdensome transition. Main predictors for transitions were age, sex and chronic conditions. A high density of home care nurses was associated with a decrease, whereas a high density of ambulatory care physicians was associated with an increase in the number of transitions.ConclusionsHealth care utilisation was high in the last six months of life and a considerable number of decedents were being transferred. Advance care planning might prevent patients from numerous and particularly from burdensome transitions.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 97%

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Health Care Utilisation and Transitions between Health Care Settings in the Last 6 Months of Life in Switzerland

Bähler

Signorell²,

Reich³

2016

PLoS ONE

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“…In Belgium and Spain, for instance, many palliative care services are based in hospitals,37 and another study has shown that GPs in these two countries cited palliative care as the reason for more than one in three terminal hospitalisations (hospital admissions during which the patient died) 38. Our data showed that the involvement of multidisciplinary palliative care teams was associated with fewer late hospitalisations in Belgium and the Netherlands, but this was not so in Italy and Spain.…”

Section: Discussionmentioning

confidence: 42%

Hospitalisations at the end of life in four European countries: a population-based study via epidemiological surveillance networks

Pivodic

Pardon

Miccinesi

et al. 2015

J Epidemiol Community Health

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BackgroundThere is a paucity of cross-national population-based research on hospitalisations of people at the end of life. We aimed to compare, in four European countries, the frequency, time, length of and factors associated with hospitalisations in the last 3 months of life.MethodsPopulation-based mortality follow-back study via Sentinel Networks of general practitioners (GPs) in Belgium, the Netherlands, Italy and Spain. Using a standardised form, GPs recorded the care in the last 3 months of life of every deceased practice patient (≥18 years; 1 January 2009 to 31 December 2011). Sudden deaths were excluded.ResultsWe studied 4791 deaths that GPs described as non-sudden (66% of all registered deaths). Between 49% (the Netherlands) and 56% (Belgium) of patients were hospitalised at least once in the last 3 months of life. Readmissions were less frequent in the Netherlands (8%) than in the other countries (15–20%, p<0.001). Chances of being hospitalised increased over the last 10 days of life across countries but remained lowest in the Netherlands (Belgium: 21–37%, the Netherlands: 15–29%, Italy: 16–37%, Spain: 14–31%). Hospitalisations in the last week of life were more likely if patients resided at home rather than in a care home (ORs and 95% CIs Belgium: 1.94 (1.28 to 2.94); the Netherlands: 2.61 (1.10 to 6.18); Spain: 4.72 (1.64 to 13.57); non-significant in Italy) and less likely if the GP knew the patient's preferred place of death (ORs and 95% CIs Belgium: 0.52 (0.36 to 0.74); the Netherlands: 0.48 (0.25 to 0.91); Spain: 0.24 (0.13 to 0.44), non-significant in Italy).ConclusionsThe use of hospitals at the end-of-life increased over the last weeks of life of patients in all countries studied, but remained lowest in the Netherlands, as did the rate of readmissions. This may be due to gatekeeping by GPs who are trained and supported in preventing hospital readmissions at the end of life.

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“…Second, in order to prevent hospital admissions for palliative patients, health services often focus on the implementation of ACP in the primary care setting and nursing homes [4][5][6][7][8][9][10][11]. However, still many palliative patients reside and die in the hospital setting [12][13][14][15][16]. When admitted to the hospital, palliative patients often experience the disease and treatment burden strongly.…”

Section: Introductionmentioning

confidence: 99%

What do hospital professionals report as helping in overcoming obstacles for ACP decision-making? A qualitative study

Vanderhaeghen¹,

Bossuyt²,

Menten³

et al. 2017

Int Clin Med

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Background: Advance Care Planning (ACP) can be defined as an ongoing process of communication between patients and (in-) formal caregivers to help an individual identify, reflect upon, discuss, and express her or his values, beliefs, goals, and priorities to guide individual care and treatment decision making when nearing end of life. Studies suggest ACP is not well implemented in the hospital setting. This contrast sharply to the necessity of those conversations in hospitals: treatment decisions are made which potentially have a big impact on the patient's and families quality of life. AIMS: In order to facilitate the implementation of the ACP decision making process in hospital, it might be interesting to know what helps hospital professionals to overcome challenges.

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Transitions between health care settings in the final three months of life in four EU countries

Abstract: End-of-life transitions between health care settings are common across EU countries, in particular late hospitalizations for people residing at home. Frequency, type and reasons for terminal hospitalizations vary between countries.

Cited by 59 publications

References 39 publications

Health Care Utilisation and Transitions between Health Care Settings in the Last 6 Months of Life in Switzerland

Health Care Utilisation and Transitions between Health Care Settings in the Last 6 Months of Life in Switzerland

Hospitalisations at the end of life in four European countries: a population-based study via epidemiological surveillance networks

What do hospital professionals report as helping in overcoming obstacles for ACP decision-making? A qualitative study

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