INTENSIVE CARE UNIT USE AT THE END OF LIFE: A POPULATION-BASED ANALYSIS

2004 ◽  
Vol 32 (Supplement) ◽  
pp. A82
Author(s):  
Edward Seferian ◽  
Arthur Williams
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
End Of Life ◽  
Population Based

Variation in end-of-life care and hospital palliative care among hospitals and local authorities: A preliminary contribution of big data

2021 ◽  
pp. 026921632110192
Author(s):  
Michael K. Gusmano ◽  
Victor G. Rodwin ◽  
Daniel Weisz ◽  
Jonathan Cottenet ◽  
Catherine Quantin
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
End Of Life ◽  
Population Based ◽  
Local Authorities ◽  
Medical Centers ◽  
Academic Medical ◽  
Geographic Differences ◽  
Insurance Database

Background: Many studies explore the clinical and ethical dimensions of care at the end-of-life, but fewer use administrative data to examine individual and geographic differences, including the use of palliative care. Aim: Provide a population-based perspective on end-of-life and hospital palliative care among local authorities and hospitals in France. Design: Retrospective cohort study of care received by 17,928 decedents 65 and over (last 6 months of life), using the French national health insurance database Results: 55.7% of decedents died in acute-care hospitals; 79% were hospitalized in them at least once; 11.7% were admitted at least once for hospital palliative care. Among 31 academic medical centers, intensive care unit admissions ranged from 12% to 67.4%; hospital palliative care admissions, from 2% to 30.6%. Across local authorities, for intensive care unit days and hospital palliative care admissions, the ratios between the values at the third and the first quartile were 2.4 and 1.5. The odds of admission for hospital palliative care or to an intensive care unit for more than 7 days were more than twice as high among people ⩽85 years (aOR = 2.11 (1.84–2.43) and aOR = 2.59 (2.12–3.17), respectively). The odds of admission for hospital palliative care were about 25% lower ( p = 0.04) among decedents living in local authorities with the lowest levels of education than those with the highest levels. Conclusion: The variation we document in end-of-life and hospital palliative care across different categories of hospitals and 95 local authorities raises important questions as to what constitutes appropriate hospital use and intensity at the end-of-life.

Practice of end-of-life care in intensive care unit. A national survey

2011 ◽  
Vol 59 (S 01) ◽  
Author(s):  
C Schimmer ◽  
C Yildirim ◽  
M Oezkur ◽  
SP Sommer ◽  
B Hörning ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
End Of Life ◽  
National Survey ◽  
End Of Life Care ◽  
Life Care

Transparency in end-of-life care in the intensive care unit

2011 ◽  
Vol 39 (9) ◽  
pp. 2207-2208
Author(s):  
Mohamed Y. Rady ◽  
Joseph L. Verheijde
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care

Predictors of and Trends in High-Intensity End-of-Life Care Among Children With Cancer: A Population-Based Study Using Health Services Data

2017 ◽  
Vol 35 (2) ◽  
pp. 236-242 ◽  
Author(s):  
Alisha Kassam ◽  
Rinku Sutradhar ◽  
Kimberley Widger ◽  
Adam Rapoport ◽  
Jason D. Pole ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Health Services ◽  
High Intensity ◽  
Hematologic Malignancies ◽  
Population Based ◽  
Children With Cancer ◽  
Eol Care ◽  
Related Mortality

Purpose Children with cancer often receive high-intensity (HI) medical care at the end-of-life (EOL). Previous studies have been limited to single centers or lacked detailed clinical data. We determined predictors of and trends in HI-EOL care by linking population-based clinical and health-services databases. Methods A retrospective decedent cohort of patients with childhood cancer who died between 2000 and 2012 in Ontario, Canada, was assembled using a provincial cancer registry and linked to population-based health-care data. Based on previous studies, the primary composite measure of HI-EOL care comprised any of the following: intravenous chemotherapy < 14 days from death; more than one emergency department visit; and more than one hospitalization or intensive care unit admission < 30 days from death. Secondary measures included those same individual measures and measures of the most invasive (MI) EOL care (eg, mechanical ventilation < 14 days from death). We determined predictors of outcomes with appropriate regression models. Sensitivity analysis was restricted to cases of cancer-related mortality, excluding treatment-related mortality (TRM) cases. Results The study included 815 patients; of these, 331 (40.6%) experienced HI-EOL care. Those with hematologic malignancies were at highest risk (odds ratio, 2.5; 95% CI, 1.8 to 3.6; P < .001). Patients with hematologic cancers and those who died after 2004 were more likely to experience the MI-EOL care (eg, intensive care unit, mechanical ventilation, odds ratios from 2.0 to 5.1). Excluding cases of TRM did not substantively change the results. Conclusion Ontario children with cancer continue to experience HI-EOL care. Patients with hematologic malignancies are at highest risk even when excluding TRM. Of concern, rates of the MI-EOL care have increased over time despite increased palliative care access. Linking health services and clinical data allows monitoring of population trends in EOL care and identifies high-risk populations for future interventions.

Population-based assessment of intensive care unit-acquired bloodstream infections in adults: Incidence, risk factors, and associated mortality rate

2002 ◽  
Vol 30 (11) ◽  
pp. 2462-2467 ◽  
Author(s):  
Kevin B. Laupland ◽  
David A. Zygun ◽  
H. Dele Davies ◽  
Deirdre L. Church ◽  
Thomas J. Louie ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Mortality Rate ◽  
Bloodstream Infections ◽  
Population Based ◽  
Incidence Risk
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