Healthcare inequalities in emergency visits and hospitalisation at the end of life: a study of 395 019 public hospital records

2021 ◽  
pp. bmjspcare-2020-002800
Author(s):  
Roger Yat-Nork Chung ◽  
Derek Chun Kiu Lai ◽  
Alvin Yik-Kiu Hui ◽  
Patsy Yuen-Kwan Chau ◽  
Eliza Lai-Yi Wong ◽  
...  
Keyword(s):  
Hong Kong ◽  
End Of Life ◽  
Hospital Admissions ◽  
Secondary Data ◽  
Public Hospitals ◽  
Emergency Visits ◽  
Elderly Home ◽  
Care Services ◽  
Lower Socioeconomic ◽  
Hospital Utilisation

ObjectivesTo investigate whether there were any socioeconomic disparities in utilisation of hospital care services during end of life in Hong Kong.MethodsSecondary data analyses were conducted using frequency of the accident and emergency (A&E) department visits and hospital admissions during the last year of life in all public hospitals from 2004 to 2014 in Hong Kong. A total of 1 237 044 A&E records from 357 853 patients, and 1 878 982 admission records from 375 506 patients were identified for analyses. In total, 395 019 unique deceased patients were identified from both datasets.ResultsRegression analyses showed that comprehensive social security assistance (CSSA) recipients used A&E services 1.29 times more than the non-recipients. Being either a CSSA recipient or an elderly home resident was more likely to be admitted to hospitals and stayed longer. Elderly home residents tended to stay longer than those from the community in the earlier months during the last year of life regardless of CSSA status; however, non-elderly home residents surpassed the residents in the duration of stay at hospitals towards the later months of the last year of life. There were also significant differences in hospital utilisation across various districts of residence.ConclusionsPeople of lower socioeconomic position tend to have higher emergency visits and hospitalisation during their last year of life in Hong Kong, implying the presence of health inequality during end of life. However, due to Hong Kong’s largely pro-rich primary care system, the predominantly public A&E and inpatient services may inadvertently act as a mitigator of such health inequalities.

scholarly journals Attitudes and educational needs of emergency doctors providing palliative and end-of-life care in Hong Kong: a cross-sectional analysis based on a self-report study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Kwun Hang Wong ◽  
Li Chuan Marc Yang ◽  
Kam Wing Raymond Woo ◽  
Oi Fung Wong ◽  
Wing Yan Kwong ◽  
...  
Keyword(s):  
Palliative Care ◽  
Hong Kong ◽  
End Of Life ◽  
Educational Needs ◽  
Comfort Level ◽  
Self Report ◽  
Ageing Population ◽  
Care Services ◽  
Eol Care ◽  
Emergency Doctors

Abstract Background Due to the ageing population in Hong Kong, the importance and need of palliative care and end-of-life (EOL) care are coming under the spotlight. The objectives of this study were to evaluate the attitudes of emergency doctors in providing palliative and EOL care in Hong Kong, and to investigate the educational needs of emergency doctors in these areas. Methods A questionnaire was used to study the attitudes of ED doctors of six different hospitals in Hong Kong. The questionnaire recorded the attitudes of the doctors towards the role of palliative and EOL care in EDs, the specific obstacles faced, their comfort level and further educational needs in providing such care. The attitudes of emergency doctors of EDs with EOL care services were compared with those of EDs without such services. Results In total, 145 emergency doctors completed the questionnaire, of which 60 respondents were from EDs with EOL care services. A significant number of participants recognized that the management of the dying process was essential in ED. Providing palliative and EOL care is also accepted as an important competence and responsibility, but the role and priority of palliative and EOL care in ED are uncertain. Lack of time and access to palliative care specialists/ teams were the major barriers. Doctors from EDs with EOL care services are more comfortable in providing such care and discuss it with patients and their relatives. Further educational needs were identified, including the management of physical complaints, communication skills, and EOL care ethics. Conclusions The study identified obstacles in promoting palliative and EOL care in the EDs Hong Kong. With the combination of elements of routine ED practice and a basic palliative medicine skill set, it would promote the development of palliative and EOL care in Emergency Medicine in the future.

scholarly journals Factors associated with variation in hospital use at the end of life in England

2016 ◽  
Vol 9 (2) ◽  
pp. 167-174 ◽  
Author(s):  
Martin Bardsley ◽  
Theo Georghiou ◽  
Ruth Spence ◽  
John Billings
Keyword(s):  
End Of Life ◽  
Hospital Admissions ◽  
Explanatory Power ◽  
Diagnostic Group ◽  
Patient Specific ◽  
The Past ◽  
Lengths Of Stay ◽  
Bed Days ◽  
Hospital Utilisation ◽  
Hospital Use

ObjectiveTo identify the relative importance of factors influencing hospital use at the end of life.DesignRetrospective cohort study of person and health system effects on hospital use in the past 12 months modelling differences in admissions, bed days and whether a person died in hospital.SettingResidents in England for the period 2009/2010 to 2011/2012 using Hospital Episodes Statistics (HES) data from all acute care hospitals in England funded by the National Health Service (NHS).Participants1 223 859 people registered with a GP in England who died (decedents) in England (April 2009–March 2012) with a record of NHS hospital care.Main outcome measuresHospital admissions, and hospital bed days and place of death (in or out of hospital) in the past 12 months of life.ResultsThe mean number of admissions in the past 12 months of life averaged 2.28 occupying 30.05 bed days—excluding 9.8% of patients with no hospital history. A total of 50.8% of people died in hospital. Difference in hospital use was associated with a range of patient descriptors (age, gender and ethnicity). The variables with the greatest ‘explanatory power’ were those that described the diagnoses and causes of death. So, for example, 65% of the variability in the model of hospital admissions was explained by diagnoses. Only moderate levels of variation were explained by the hospital provider variables for admissions and deaths in hospital, though the impacts on total bed days was large.ConclusionsComparative analyses of hospital utilisation should standardise for a range of patient specific variables. Though the models indicated some degree of variability associated with individual providers, the scale of this was not great for admissions and death in hospital but the variability associated with length of stay differences suggests that attempts to optimise hospital use should look at differences in lengths of stay and bed use. This study adds important new information about variability in admissions by diagnostic group, and variability in bed days by diagnostic group and eventual cause of death.

scholarly journals Factors associated with the aggressiveness of care at the end of life for patients with cancer dying in hospital: a nationwide retrospective cohort study in mainland Portugal

ESMO Open ◽  
2020 ◽  
Vol 5 (6) ◽  
pp. e000953
Author(s):  
Diogo Martins-Branco ◽  
Silvia Lopes ◽  
Rita Canario ◽  
Joao Freire ◽  
Madalena Feio ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Metastatic Disease ◽  
Medical Oncology ◽  
Public Hospitals ◽  
Factors Associated ◽  
Patients With Cancer ◽  
Care Services ◽  
Mainland Portugal ◽  
Palliative Care Services

IntroductionThere is growing concern about the aggressiveness of cancer care at the end of life (ACCEoL), defined as overly aggressive treatments that compromise the quality of life at its end. Recognising the most affected patients is a cornerstone to improve oncology care. Our aim is to identify factors associated with ACCEoL for patients with cancer dying in hospitals.MethodsAll adult patients with cancer who died in public hospitals in mainland Portugal (January 2010 to December 2015), identified from the hospital morbidity database. This database provided individual clinical and demographic data. We obtained hospital and region-level variables from a survey and National Statistics. The primary outcome is a composite ACCEoL measure of 16 indicators. We used multilevel random effects logistic regression modelling (p<0·05).ResultsWe included 92 155 patients: median age 73 years; 62% male; 53% with metastatic disease. ACCEoL prevalence was 71% (95% CI 70% to 71%). The most prevalent indicators were >14 days in the hospital (43%, 42–43) and surgery (28%, 28–28) in the last 30 days. Older age (p<0·001), breast cancer (OR 0·83; 95% CI 0·76 to 0·91), and metastatic disease (0·54; 95% CI 0·50 to 0·58) were negatively associated with ACCEoL. In contrast, higher Deyo-Charlson Comorbidity Index (p<0·001), gastrointestinal and haematological malignancies (p<0·001), and death at cancer centre (1·31; 95% CI 1·01 to 1·72) or hospital with medical oncology department (1·29; 95% CI 1·02 to 1·63) were positively associated with ACCEoL. There was no association between hospital palliative care services at the hospital of death and ACCEoL.ConclusionClinical factors related to a better understanding of disease course are associated with ACCEoL reduction. Patients with more comorbidities and gastrointestinal malignancies might represent groups with complex needs, and haematological patients may be at increased risk because of unpredictable prognosis. Improvement of hospital palliative care services could help reduce ACCEoL, particularly in cancer centres and hospitals with medical oncology department, as those services are usually under-resourced, thus reaching few.

scholarly journals Understanding the impact and causes of ‘failure to attend’ on continuity of care for patients with chronic conditions

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247914
Author(s):  
Amy-Louise Byrne ◽  
Adele Baldwin ◽  
Clare Harvey ◽  
Janie Brown ◽  
Eileen Willis ◽  
...  
Keyword(s):  
Chronic Conditions ◽  
Hospital Admissions ◽  
Hospital Setting ◽  
Public Hospitals ◽  
Multiple Chronic Conditions ◽  
Outpatient Services ◽  
Nurse Navigator ◽  
Hospital Utilisation ◽  
The Impact ◽  
Causes Of Failure

Aim To understand the impact and causes of ‘Failure to Attend’ (FTA) labelling, of patients with chronic conditions. Background Nurse navigators are registered nurses employed by public hospitals in Queensland, Australia, to coordinate the care of patients with multiple chronic conditions, who frequently miss hospital appointments. The role of the nurse navigator is to improve care management of these patients. Evidence for this is measured through improvement in patient self-management of their conditions, a reduction in preventable hospital admissions and compliance with attendance at outpatient clinics. Failure to attend (FTA) is one measure of hospital utilisation, identifying outpatient appointments that are cancelled or not attended. Method The cohort for this study was patients with multiple chronic conditions, and nurse navigators coordinating their care. Data describing the concept of FTA were thematically analysed twelve months into this three year evaluation. Results Although the patient is blamed for failing to attend appointments, the reasons appear to be a mixture of systems error/miscommunication between the patient and the health services or social reasons impacting on patient’s capacity to attend. Themes emerging from the data were: access barriers; failure to recognise personal stigma of FTA; and bridging the gap. Conclusion The nurse navigators demonstrate their pivotal role in engaging with outpatient services to reduce FTAs whilst helping patients to become confident in dealing with multiple appointments. There are many reasons why a patient is unable to attend a scheduled appointment. The phrase ‘Failure to Attend’ has distinctly negative connotations and can lead to a sense of blame and shame for those with complex chronic needs. We propose the use of the neutral phrase “appointment did not proceed” to replace FTA. Implications for Nursing management This article advocates for further consideration of collaborative models that engage the patient in their care journey and for consideration of the language used within the outpatient acute hospital setting, proposing the term ‘appointment did not proceed.’

THE QUALITY OF PUBLIC HOSPITALS IN CAN THO CITY, 2016

2018 ◽  
Vol 8 (6) ◽  
pp. 76-81
Author(s):  
Chu Cao Minh ◽  
Thang Vo Van ◽  
Dat Nguyen Tan ◽  
Hung Vo Thanh
Keyword(s):  
Hospital Medicine ◽  
Secondary Data ◽  
Quality Criterion ◽  
Quality Criteria ◽  
Public Hospitals ◽  
Ministry Of Health ◽  
Cross Sectional ◽  
Significant Difference ◽  
Can Tho City

Background: The criteria set of assessing hospital quality in Vietnam in 2016 was revied from the criteria set in 2013 by the Ministry of Health in order to help hospitals to self-assess towards improvinge quality of hospitals in the international integration context. The study aimed to assess the quality of public hospitals in Can Tho City according to the revised criteria set of the Ministry of Health in 2016 and compare the quality among three hospital ranks (including grade I, grade II, and grade III) via to 5 groups of quality criteria. Methods: A cross-sectional study, using secondary data analysis was applied to assess the service quality of 7 general public hospitals in Can Tho City. Results: The average total score of 7 hospitals is 245 and the average for the criteria of 7 hospitals is 2.99, which is just satisfactory. In the criterion of quality, criterion D and E had the lowest scores compared to the other three groups. There was no statistically significant difference (p = 0.076) among the mean scores for the three hospital categories. Conclusion: The quality of public hospitals in Can Tho city in 2016 only reached moderately good level (2.99). Interventions should be developed to improve the quality of hospitals, with particular emphasis on improving the quality of criteria groups D and E. Key words: Quality, hospital, medicine, health, public, Can Tho

scholarly journals Implementing an Integrated Large-Scale Clinical Information System for ISSSTE’s Hospital Network in Mexico

2021 ◽  
Vol 3 (2) ◽  
pp. 444-453
Author(s):  
Arturo Cervantes Trejo ◽  
Sophie Domenge Treuille ◽  
Isaac Castañeda Alcántara
Keyword(s):  
Health Care ◽  
Information System ◽  
Health Care Services ◽  
Large Scale ◽  
Clinical Information System ◽  
Clinical Information ◽  
Public Hospitals ◽  
Care Services ◽  
Cost Reductions

AbstractThe Institute for Security and Social Services for State Workers (ISSSTE) is a large public provider of health care services that serve around 13.2 million Mexican government workers and their families. To attain process efficiencies, cost reductions, and improvement of the quality of diagnostic and imaging services, ISSSTE was set out in 2019 to create a digital filmless medical image and report management system. A large-scale clinical information system (CIS), including radiology information system (RIS), picture archiving and communication system (PACS), and clinical data warehouse (CDW) components, was implemented at ISSSTE’s network of forty secondary- and tertiary-level public hospitals, applying global HL-7 and Digital Imaging and Communications in Medicine (DICOM) standards. In just 5 months, 40 hospitals had their endoscopy, radiology, and pathology services functionally interconnected within a national CIS and RIS/PACS on secure private local area networks (LANs) and a secure national wide area network (WAN). More than 2 million yearly studies and reports are now in digital form in a CDW, securely stored and always available. Benefits include increased productivity, reduced turnaround times, reduced need for duplicate exams, and reduced costs. Functional IT solutions allow ISSSTE hospitals to leave behind the use of radiographic film and printed medical reports with important cost reductions, as well as social and environmental impacts, leading to direct improvement in the quality of health care services rendered.

scholarly journals Delivering Community Emergency Medicine during the COVID-19 pandemic: the Physician Response Unit

2021 ◽  
Vol 38 (5) ◽  
pp. 371-372
Author(s):  
Rich Carden ◽  
Bill Leaning ◽  
Tony Joy
Keyword(s):  
Emergency Medicine ◽  
Emergency Care ◽  
Hospital Admissions ◽  
Hospital Setting ◽  
Response Unit ◽  
Care Services ◽  
Vulnerable Patients ◽  
Palliative Care Services ◽  
Alternative Solutions ◽  
Physician Response

The COVID-19 pandemic has presented significant challenges to services providing emergency care, in both the community and hospital setting. The Physician Response Unit (PRU) is a Community Emergency Medicine model, working closely with community, hospital and pre-hospital services. In response to the pandemic, the PRU has been able to rapidly introduce novel pathways designed to support local emergency departments (EDs) and local emergency patients. The pathways are (1) supporting discharge from acute medical and older people’s services wards into the community; (2) supporting acute oncology services; (3) supporting EDs; (4) supporting palliative care services. Establishing these pathways have facilitated a number of vulnerable patients to access patient-focussed and holistic definitive emergency care. The pathways have also allowed EDs to safely discharge patients to the community, and also mitigate some of the problems associated with trying to maintain isolation for vulnerable patients within the ED. Community Emergency Medicine models are able to reduce ED attendances and hospital admissions, and hence risk of crowding, as well as reducing nosocomial risks for patients who can have high-quality emergency care brought to them. This model may also provide various alternative solutions in the delivery of safe emergency care in the postpandemic healthcare landscape.

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