scholarly journals Healthcare use and cost trajectories during the last year of life: A national population administrative secondary care data linkage study

2020 ◽  
Author(s):  
Katharina Diernberger ◽  
Xhyljeta Luta ◽  
Joanna Bowden ◽  
Marie Fallon ◽  
Joanne Droney ◽  
...  
Keyword(s):  
End Of Life ◽  
Secondary Care ◽  
Urban Areas ◽  
Data Linkage ◽  
Hospital Admissions ◽  
Community Support ◽  
Linkage Study ◽  
Healthcare Use ◽  
Admission Rates ◽  
Mean Cost

Abstract Background: People 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. Objectives: To describe the pattern, trajectory and drivers of secondary care use and cost by people in Scotland in their last year of life. Methods: Retrospective whole-population secondary care administrative data linkage study of Scottish decedents of 60 years and over between 2012 and 2017 (N=274,048). Results: Secondary care use was high in the last year of life with a sharp rise in inpatient admissions in the last three months. The mean cost was 10,000 pound. 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. Conclusions: Hospitalisation 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.

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

2021 ◽  
pp. bmjspcare-2020-002708
Author(s):  
Katharina Diernberger ◽  
Xhyljeta Luta ◽  
Joanna Bowden ◽  
Marie Fallon ◽  
Joanne Droney ◽  
...  
Keyword(s):  
End Of Life ◽  
Secondary Care ◽  
Urban Areas ◽  
Data Linkage ◽  
Hospital Admissions ◽  
Community Support ◽  
Population Data ◽  
Linkage Study ◽  
Healthcare Use ◽  
Admission Rates

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.

Patterns and costs of hospital-based cancer care in the last year of life: A national data linkage study in Scotland.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18732-e18732
Author(s):  
Katharina Diernberger ◽  
Joanna Bowden ◽  
Marie T. Fallon ◽  
Xhyljeta Luta ◽  
Joanne Droney ◽  
...  
Keyword(s):  
Cause Of Death ◽  
Advanced Cancer ◽  
Linear Models ◽  
Data Linkage ◽  
Hospital Admissions ◽  
Linkage Study ◽  
Healthcare Use ◽  
Day Case ◽  
Admission Rates ◽  
One Year

e18732 Background: Approximately thirty thousand people in Scotland are diagnosed with cancer each year, of whom 10,000 live less than one year. Hospital is the most common place of death for people with cancer, despite most expressing a preference for community-based care. There is inadequate understanding of the nature and value of hospital-based care for people with advanced cancer. This study aimed to describe patterns of hospital-based healthcare use and associated costs for cancer decedents in their last year of life. Methods: A population-wide administrative data linkage study of hospital-based healthcare use for cancer decedents aged 60+ at death who died between 2012 and 2017 was conducted in Scotland. Linkage was established between the Scottish Morbidity Record, Scottish Cancer Registry and the National Records of Scotland. Hospital admissions, length of stay (LoS), number and nature of outpatient and day case appointments were extracted. Associated costs were estimated using generalised linear models, adjusted for age, gender, primary cause of death, socioeconomic deprivation status, rural-urban (RU) status and comorbidity. Results: The study population included 85,732 decedents with a cancer diagnosis, for whom 64,553 (75.3%) cancer was the underlying cause of death. Mean age at death was 84 years. The mean number of inpatient stays in the last year of life was 5.88 (SD 5.68), with a mean LoS of 7 days. Mean total 1-year inpatient, outpatient and day-case costs per patient were £10,261, £1,275 and £977 respectively. People who died of haematological cancers had the most hospital admissions (mean 11.8). Admission rates rose sharply in the last month of life and were most common in those who died of haematological and lung cancers. One year adjusted and unadjusted costs decreased with increasing age. Unadjusted costs for the youngest group (60-64) were £15,895, double the cost for those aged 90+. People dying of haematological cancers had the highest hospital-based costs (mean £24,772) followed by those with ovarian cancer (mean £17,556). The largest single contributor to hospital-based costs in the last year of life was unscheduled admissions. Conclusions: People in Scotland in their last year of life with cancer use substantial hospital-based care. Unscheduled admission rates are high, particularly in the last month of life when the value of acute intervention may be uncertain. Further research is needed to examine triggers for hospitalisation and to assess the value of hospital-based care to people living with advanced cancer.

scholarly journals Area Deprivation, Urbanicity and Severe Mental Illness – A Population-Based Linkage Study Using Routinely Collected Primary and Secondary Care Data

2019 ◽  
Vol 4 (3) ◽  
Author(s):  
Sze Chim Lee ◽  
Marcos Delpozo-Banos ◽  
Keith Lloyd ◽  
Ian Jones ◽  
James TR Walters ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Secondary Care ◽  
Urban Areas ◽  
Lower Layer ◽  
Population Based ◽  
Linkage Study ◽  
Mental Illnesses ◽  
Area Deprivation ◽  
Small Area Statistics ◽  
Urban Rural

Background There is a long-standing debate regarding the associations between area deprivation, urbanicity and elevated risk of severe mental illnesses (SMIs). Main Aim We investigated the associations between area deprivation, urbanicity and risk of SMIs in a population cohorts in Wales. Methods/Approach We extracted primary and secondary care electronic health records from 2004 to 2015 from Wales’s population. We identified prevalent and incident individuals with SMIs (schizophrenia related disorders and bipolar disorder) and their level of deprivation and urbanicity. We used the Welsh Index of Multiple Deprivation (WIMD) and urban/rural indicator to measure the level of area deprivation and urbanicity respectively for all lower layer super output areas, the geographic units used in the reporting of small area statistics comprised of approximately 1,500 individuals. Results Prevalence and incidence of SMIs is not evenly distributed in Wales. Increased prevalence and incidence of SMIs occur in more deprived and urban areas. Such associations occur for both schizophrenia related disorders and bipolar disorder and in both the primary and secondary care cohorts. Conclusion These findings have implications for resource allocation, service configuration and access to services in deprived communities, as well as, for broader public health interventions addressing poverty, and social and environmental contexts.

scholarly journals Cardiovascular disease treatment among patients with severe mental illness: a data linkage study between primary and secondary care

2016 ◽  
Vol 66 (647) ◽  
pp. e374-e381 ◽  
Author(s):  
Charlotte Woodhead ◽  
Mark Ashworth ◽  
Matthew Broadbent ◽  
Felicity Callard ◽  
Matthew Hotopf ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Secondary Care ◽  
Data Linkage ◽  
Linkage Study ◽  
Disease Treatment

105: HEALTHCARE USE BEFORE AND AFTER CRITICAL CARE: A POPULATION-BASED DATA LINKAGE STUDY

2020 ◽  
Vol 48 (1) ◽  
pp. 35-35
Author(s):  
Tamas Szakmany ◽  
Mohammad Al Sallakh ◽  
Ashley Akbari ◽  
Richard Pugh ◽  
Ronan Lyons
Keyword(s):  
Critical Care ◽  
Data Linkage ◽  
Population Based ◽  
Linkage Study ◽  
Healthcare Use ◽  
Before And After

scholarly journals Hospital admissions in children with cerebral palsy: a data linkage study

2016 ◽  
Vol 59 (5) ◽  
pp. 512-519 ◽  
Author(s):  
Elaine Meehan ◽  
Susan M Reid ◽  
Katrina Williams ◽  
Gary L Freed ◽  
Jillian R Sewell ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Data Linkage ◽  
Hospital Admissions ◽  
Linkage Study ◽  
Children With Cerebral Palsy

scholarly journals Understanding which people with dementia are at risk of inappropriate care and avoidable transitions to hospital near the end-of-life: a retrospective cohort study

2019 ◽  
Vol 48 (5) ◽  
pp. 672-679 ◽  
Author(s):  
Javiera Leniz ◽  
Irene J Higginson ◽  
Robert Stewart ◽  
Katherine E Sleeman
Keyword(s):  
Cohort Study ◽  
End Of Life ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Hospital Admissions ◽  
Care Home ◽  
Mental Health Provider ◽  
Healthcare Use ◽  
Hospital Data ◽  
People With Dementia

Abstract Background transitions between care settings near the end-of-life for people with dementia can be distressing, lead to physical and cognitive deterioration, and may be avoidable. Objective to investigate determinants of end-of-life hospital transitions, and association with healthcare use, among people with dementia. Design retrospective cohort study. Setting electronic records from a mental health provider in London, linked to national mortality and hospital data. Subjects people with dementia who died in 2007–2016. Methods end-of-life hospital transitions were defined as: multiple admissions in the last 90 days (early), or any admission in the last three days of life (late). Determinants were assessed using logistic regression. Results of 8,880 people, 1,421 (16.0%) had at least one end-of-life transition: 505 (5.7%) had early, 788 (8.9%) late, and 128 (1.5%) both types. Early transitions were associated with male gender (OR 1.33, 95% CI 1.11–1.59), age (>90 vs <75 years OR 0.69, 95% CI 0.49–0.97), physical illness (OR 1.52, 95% CI 1.20–1.94), depressed mood (OR 1.49, 95% CI 1.17–1.90), and deprivation (most vs least affluent quintile OR 0.58, 95% CI 0.37–0.90). Care home residence was associated with fewer early (OR 0.63, 95% CI 0.53 to 0.76) and late (OR 0.80, 95% CI 0.65 to 0.97) transitions. Early transitions were associated with more hospital admissions throughout the last year of life compared to those with late and no transitions (mean 4.56, 1.89, 1.60; P < 0.001). Conclusions in contrast to late transitions, early transitions are associated with higher healthcare use and characteristics that are predictable, indicating potential for prevention.

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