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

e18769 Background: Delivery of high quality cancer care is associated with rising costs, both in earlier stages of the illness trajectory and at the end of life. A significant portion of the costs and health care utilisation occurs in the last year of life. Most publications to date have focused on costs in hospital. Little is known about the costs of care for cancer patients across the entire health service. The aim was to examine primary, secondary and acute health care utilisation and cost in the last 12 months of life and how these differ by cancer diagnosis and other patient characteristics among decedent patients aged 60 and over. Methods: We conducted a retrospective cohort study of people aged 60 years and over (N=26,077) who died in England between 2010 and 2017. We used routinely collected and linked data from primary care (Clinical Practice Research Datalink (CPRD) secondary and acute care, (Hospital Episode Statistics (HES), and death data (Office for National Statistics (ONS)). This provided a nationally representative sample of the English population. We analysed of healthcare utilisation and resource use amongst decedents by gender, primary cause of death, age, geography, socio-economic status and comorbidities. Results: Overall, 90.2 % of the cancer decedents were admitted in the hospital at least once in the last 12 months of life. About 50% of patients we admitted to hospital in the last month of life with 37.6 being admitted to the hospital more than once in the last month of life. The health care utilisation and costs increased sharply in the last month of life. life. The mean number of hospital admissions in the last year of life was 3.7 (SD, 5.8). Those dying of haematological cancers (N=2093) had highest number of hospital admissions (mean:7.2, SD:10.8) and longer average hospital stay (mean:36.7, SD:33.0) (mean:12.0, SD:14.4). Use of outpatient services was highest in the group dying of haematological cancers (mean:12.0, SD:14.4) whereas those dying of prostate cancer (N= 2197) had higher number of emergency (mean:2.0, SD: 1.9) and GP visits (mean:30.8, SD: 20.7). Healthcare costs were highest among haematological cancers and lowest among those dying of breast cancer. Proximity to death and comorbidities were the main contributors of end-of-life care health care utilisation and costs. Conclusions: This study uses large linked datasets (linked to the whole spectrum of hospital episode statistics) providing a comprehensive picture of healthcare services accessed by cancer patients at end of life in England. There is significant variation in use and cost of care for cancer patients in the last year and month of life. Further analysis of variation according to hospice, palliative, and social care service provision may identify strategies to address this variation.

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Palliative care and end-of-life health utilization in elder patients with pancreatic cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.488 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 488-488

Author(s):

Nizar Bhulani ◽

Ang Gao ◽

Arjun Gupta ◽

Jenny Jing Li ◽

Chad Guenther ◽

...

Keyword(s):

Health Care ◽

Pancreatic Cancer ◽

Intensive Care Unit ◽

Palliative Care ◽

Intensive Care ◽

Health Care Utilization ◽

End Of Life ◽

Cancer Patients ◽

Cost Of Care ◽

Care Utilization

488 Background: Prospective trials have shown that palliative care is associated with improved survival and quality of life, with lower rate of end-of-life health care utilization and cost. We examined trends in palliative care utilization in older pancreatic cancer patients. Methods: Pancreatic cancer patients with and without palliative care consults were identified using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database between 2000 and 2009. Trend of palliative care use was studied. Emergency room and Intensive Care utilization and costs in the last 30 days of life were assessed. Statistical analyses were performed with SAS version 9.4 (SAS Institute, Inc., Cary, NC). Results: Of the 72205 patients with pancreatic cancer, 3383 (4.1%) received palliative care. The proportion of patients receiving palliative care increased from 1.8% in 2000 to 7.8% in 2009 (p for trend < 0.001). Patients with palliative care were more likely to be Asian and women. Of those who received palliative care, 73% received it in the last 30 days of life, and only 11% at least 12 weeks before death. The average number of visits to the ED in the last 30 days of life were significantly higher for patients who received palliative care (0.93±0.62) versus those who did not (0.79±0.61), p < 0.001, and had a significantly higher cost of care ($1317 vs $842, p < 0.001). Intensive care unit length of stay in the last 30 days of life did not differ between patients who did and did not receive palliative care (1.14 days vs 1.04 days, p 0.08). Intensive care unit cost of care was significantly higher for patients with palliative care compared to their counterparts ($5202.641 vs $3896.750, p < 0.001). Conclusions: Palliative care use for pancreatic cancer patients has increased between 2000 and 2009 in this study of Medicare patients. However, it was largely offered close to the end of life and was not associated with reduced health care utilization or cost. Early palliative care referral may be more beneficial.

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Health impact, and economic value, of meeting housing quality standards: a retrospective longitudinal data linkage study

Public Health Research ◽

10.3310/phr06080 ◽

2018 ◽

Vol 6 (8) ◽

pp. 1-104 ◽

Cited By ~ 9

Author(s):

Sarah E Rodgers ◽

Rowena Bailey ◽

Rhodri Johnson ◽

Wouter Poortinga ◽

Robert Smith ◽

...

Keyword(s):

Health Care ◽

Emergency Department ◽

Health Outcomes ◽

Hospital Admissions ◽

Quality Standards ◽

Health Impact ◽

Health Care Utilisation ◽

Housing Quality ◽

Data Set ◽

Care Utilisation

BackgroundPoor-quality housing adversely affects residents’ health but there is a paucity of high-quality evidence to support this.ObjectiveThis research investigated the health impact of bringing housing to a national quality standard.DesignA natural experiment of improvements to housing quality analysed using repeated measures of health-care utilisation and economic outcomes at an individual person level.SettingCarmarthenshire, UK.ParticipantsA total of 32,009 residents registered for a minimum of 60 days at 8558 social homes that received housing improvements between January 2005 and March 2015.InterventionsMultiple internal and external housing improvements, including wall and loft insulation, windows and doors, heating system upgrades, new kitchens and bathrooms, garden path safety improvements and electrical system upgrades (adding power sockets, and extractor fans in kitchens and bathrooms).Main outcome measuresEmergency hospital admissions for cardiorespiratory conditions and injuries. Primary health-care utilisation for respiratory and common mental health disorders, emergency department injury attendances and health-care utilisation costs.Data sourcesCarmarthenshire County Council home address and intervention records were anonymously linked within the Secure Anonymous Information Linkage databank to demographic information from the Welsh Demographic Service data set; hospital admission data from the Patient Episode Dataset for Wales; primary care contacts and prescribed medications from general practice data; emergency department attendances from the Emergency Department Data Set; and deaths from the Office for National Statistics mortality register.MethodsThe study used a longitudinal panel design to examine changes in standard of eight housing cointervention from intervention records, and linked to individuals registered at intervention homes. Health outcomes were obtained retrospectively for each individual in a dynamic cohort and were captured for up to 123 consecutive months. An additional local authority region could not be utilised as a comparator owing to different reporting pressures resulting in the recording of a different intervention. The exposure group for each cointervention was compared with an internal reference group of people living in homes that did not receive the cointervention during their tenancy. A multilevel modelling approach was used to account for repeated observations for individuals living in intervention homes. Counts of health outcomes were analysed using negative binomial regression models to determine the effect of each cointervention that reached housing quality standards during an individual’s period of tenancy, compared with those living in properties that did not. We adjusted for potential confounding factors and for background trends in the regional general population. A cost–consequences analysis was conducted as part of the health economic evaluation.ResultsResidents aged ≥ 60 years living in homes in which electrical systems were upgraded were associated with 39% fewer admissions than those living in homes in which they were not [incidence rate ratio (IRR) 0.61, 95% confidence interval (CI) 0.53 to 0.72;p < 0.01]. Reduced admissions were also associated with windows and doors (IRR 0.71, 95% CI 0.63 to 0.81;p < 0.01), wall insulation (IRR 0.75, 95% CI 0.67 to 0.84;p < 0.01) and gardens and estates (IRR 0.73, 95% CI 0.64 to 0.83;p < 0.01) for those living in homes in which these cointervention were upgraded. There were no associations of change in emergency admissions with upgrading heating (IRR 0.91, 95% CI 0.82 to 1.01;p = 0.072), loft insulation (IRR 0.98, 95% CI 0.86 to 1.11;p = 0.695), kitchens (IRR 0.98, 95% CI 0.83 to 1.17;p = 0.843) or bathrooms (IRR 0.93, 95% CI 0.81 to 1.06;p = 0.287).LimitationsThere was no randomisation, there were incomplete data on the scale of the intervention for individual households and there were no estimates for the impact of the whole programme.ConclusionsThis complex interdisciplinary study found that hospital admissions could be avoided through improving housing quality standards.Future workAt their initiation, future non-health projects should have a built-in evaluation to allow intervention exposures to be randomly allocated to residents, with the simultaneous analysis of multiple health outcomes in one statistical model.FundingThe National Institute for Health Research Public Health Research programme.

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EXPLORING GEOSPATIAL VARIATION IN DIABETES-RELATED PRIMARY HEALTH CARE SERVICE UTILISATION AND POTENTIALLY PREVENTABLE HOSPITALISATIONS IN WESTERN AUSTRALIA

ISPRS - International Archives of the Photogrammetry, Remote Sensing and Spatial Information Sciences ◽

10.5194/isprs-archives-xlii-4-661-2018 ◽

2018 ◽

Vol XLII-4 ◽

pp. 661-670

Author(s):

B. Veenendaal ◽

C. Koh ◽

A. Saleem ◽

R. Varhol ◽

J. Xiao ◽

...

Keyword(s):

Health Care ◽

Primary Health Care ◽

Western Australia ◽

Hospital Admissions ◽

Health Care Service ◽

Health Care Utilisation ◽

Service Utilisation ◽

Department Of Health ◽

Primary Health ◽

Care Utilisation

Abstract. Greater investments and improvements in primary health care (PHC) can provide benefits in reducing the high costs of hospital admissions. Potentially preventable hospitalisations (PPH) are a health system performance indicator used to evaluate access to and effectiveness of community-based health services. The Western Australia Department of Health obtained detailed primary health care data, for the first time at the postcode level scale, and analysed its associations with PPH information for selected conditions. PHC data obtained from the Commonwealth Department of Health for the financial year 2013/14 was Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) records at postcode level. In this paper we explore the sensitivity of various benchmarks of spatial zonings for comparison of diabetes-related primary health care utilisation and potentially preventable hospitalisations and then examine the relationship between them among the various spatial zonings. From the geospatial visualisation and analysis undertaken, conclusions are drawn about the patterns and relationships between diabetes-related primary health care utilisation and potentially preventable hospitalisations. The scale of spatial zonings used for comparison is important as too large or too small areas may mask out the relative geospatial variation of diabetes-related PHC utilisation and PPH evident among postcode areas.

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High versus restricted use of home oxygen therapy, health care utilisation and the cost of care in chronic lung disease infants

European Journal of Pediatrics ◽

10.1007/s00431-004-1415-z ◽

2004 ◽

Vol 163 (6) ◽

pp. 292-296 ◽

Cited By ~ 18

Author(s):

Anne Greenough ◽

John Alexander ◽

Sal Burgess ◽

Phillip A. J. Chetcuti ◽

Sarah Cox ◽

...

Keyword(s):

Health Care ◽

Lung Disease ◽

Chronic Lung Disease ◽

Oxygen Therapy ◽

Health Care Utilisation ◽

Cost Of Care ◽

Home Oxygen Therapy ◽

Care Utilisation ◽

Restricted Use ◽

The Cost

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VARIATION IN THE CARE OF BLOOD AND BOWEL CANCER PATIENTS AT THE END OF LIFE: FEASIBILITY OF USING HOSPITAL EPISODE STATISTICS TO EXAMINE NATIONAL PATTERNS

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2013-000453b.10 ◽

2013 ◽

Vol 3 (1) ◽

pp. 127.1-128

Author(s):

E V Kane ◽

E Morris ◽

E Bolton ◽

J Wilkinson ◽

D Howell ◽

...

Keyword(s):

End Of Life ◽

Cancer Patients ◽

Bowel Cancer ◽

Hospital Episode Statistics ◽

Hospital Episode

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Perceptions of Care, Socio-Demographic Characteristics and Health Care Utilisation among Health Insurance users in Ghana

Journal of Social Sciences ◽

10.3844/jssp.2015.72.81 ◽

2015 ◽

Vol 11 (2) ◽

pp. 72-81

Author(s):

Seth Christopher Yaw Appiah

Keyword(s):

Health Care ◽

Health Insurance ◽

Health Care Utilisation ◽

Demographic Characteristics ◽

Care Utilisation ◽

Perceptions Of Care

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Mapping end-of-life and anticipatory medications in palliative care patients using a longitudinal general practice database

Palliative & Supportive Care ◽

10.1017/s1478951521000092 ◽

2021 ◽

pp. 1-7

Author(s):

H. Khalil ◽

M. Garett ◽

A. Byrne ◽

P. Poon ◽

K. Gardner ◽

...

Keyword(s):

Health Care ◽

Palliative Care ◽

General Practice ◽

End Of Life ◽

Nurse Practitioners ◽

Hospital Admissions ◽

Population Level ◽

Screening Tools ◽

Care Needs ◽

Stakeholder Consultation

Abstract Objective End-of-life and anticipatory medications (AMs) have been widely used in various health care settings for people approaching end-of-life. Lack of access to medications at times of need may result in unnecessary hospital admissions and increased patient and family distress in managing palliative care at home. The study aimed to map the use of end-of-life and AM in a cohort of palliative care patients through the use of the Population Level Analysis and Reporting Data Space and to discuss the results through stakeholder consultation of the relevant organizations. Methods A retrospective observational cohort study of 799 palliative care patients in 25 Australian general practice health records with a palliative care referral was undertaken over a period of 10 years. This was followed by stakeholders’ consultation with palliative care nurse practitioners and general practitioners who have palliative care patients. Results End-of-life and AM prescribing have been increasing over the recent years. Only a small percentage (13.5%) of palliative care patients received medications through general practice. Stakeholders’ consultation on AM prescribing showed that there is confusion about identifying patients needing medications for end-of-life and mixed knowledge about palliative care referral pathways. Significance of results Improved knowledge and information around referral pathways enabling access to palliative care services for general practice patients and their caregivers are needed. Similarly, the increased utility of screening tools to identify patients with palliative care needs may be useful for health care practitioners to ensure timely care is provided.

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