Current state of the economics of palliative and end-of-life care: A clinical view

May, Peter; Murtagh, Fliss E.M.

doi:10.1177/0269216317695680

Cited by 8 publications

(13 citation statements)

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“…This finding implies that goals of care and treatment preference discussions are necessary to minimise inappropriate treatments at the EOL. The economic impact of interventions on families and caregivers was an important but underexamined issue 30. In this study, involving family caregivers in medical decision making through PFCCM for terminally ill patients may potentially reduce ICU admissions, surgery and invasive mechanical ventilation, and lower daily medical expenditures during the final hospitalisation.…”

Section: Discussionmentioning

confidence: 99%

Impact of patient-centred and family-centred care meetings on intensive care and resource utilisation in patients with terminal illness: a single-centre retrospective observational study in Taiwan

et al. 2019

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ObjectiveShared decision making is essential for patients and their families when facing serious and life-threatening diseases. This study aimed to evaluate the impact of patient-centred and family-centred care meetings (PFCCM) on intensive measures and resource utilisation during end-of-life (EOL) hospitalisation among terminally ill patients.Design and settingA retrospective cross-sectional study using electronic medical records was conducted in a tertiary referral medical centre in Taiwan.ParticipantsWe identified 6843 deceased patients with terminal illness who either received or did not receive PFCCM during EOL hospitalisation between January 2013 and December 2015.Primary and secondary outcome measuresPatients who were transferred to the intensive care unit (ICU). Those who underwent invasive or non-invasive mechanical ventilation, tracheostomy, haemodialysis and surgical intervention during the final hospitalisation were determined by the use of intensive care measures; secondary measures were individual total and daily medical expenditures. A generalised estimating equation (GEE) model was used to compare the differences between the two groups. OR and beta coefficients (β) with 95% CI were estimated.ResultsThis study identified 459 patients (6.7%) who received PFCCM during EOL hospitalisation. Multivariate analyses showed that patients who received PFCCM were less likely to have ICU admissions (OR 0.44, 95% CI 0.34 to 0.57), undergo surgical interventions (OR 0.74, 95% CI 0.58 to 0.95) and invasive mechanical ventilation (OR 0.50, 95% CI 0.38 to 0.66) during the final hospitalisation, after adjusting for patient demographics, clinical conditions and year of admission. Additionally, a significant decrease in daily medical expenditures was observed in PFCCM patients (β −0.18, 95% CI −0.25 to −0.12) than in non-PFCCM patients.ConclusionsPatient–physician discussion through PFCCM is associated with less intensive care utilisation and daily medical expenditure during EOL hospitalisation in terminally ill patients.

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Section: Discussionmentioning

confidence: 99%

Impact of patient-centred and family-centred care meetings on intensive care and resource utilisation in patients with terminal illness: a single-centre retrospective observational study in Taiwan

et al. 2019

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“…Die aktuelle Evidenz bewertet Interventionen der Palliativversorgung als im Allgemeinen kostensparend [164]. Dies allein sollte jedoch nicht zentraler Bewertungsmaßstab sein, sondern vor allem die Versorgungsqualität.…”

Section: Gesundheitsökonomische Verfahrenunclassified

“…Neben den für Krankenkassen oder in Krankenhäusern anfallenden Kosten gilt es verstärkt auch Kosten zu betrachten, die in anderen Versorgungsstrukturen für Patientinnen und Patienten sowie ihre Angehörigen entstehen [165]. Außerdem bedarf es neben der Analyse von Krankenhausaufenthalten oder -leistungen verstärkt auch der Untersuchung ambulanter Versorgungsleistungen mit Relevanz für Erkrankungen mit längerem Verlauf [164]. Die Methoden zur Kosten-Nutzen-Bewertung wurden in der vergangenen Dekade kaum weiterentwickelt [166].…”

Section: Gesundheitsökonomische Verfahrenunclassified

“…Nur wenige Studien messen jedoch beides, also sowohl die Kosten als auch die patientenbezogenen Outcomes der Versorgung im letzten Lebensjahr. Dies ist jedochauch aufgrund der Heterogenität der Interventionen, der Settings sowie der Patientinnen und Patienten -essentiell für die Bewertung von Interventionen [164]. Dafür bedarf es meist der Kombination unterschiedlicher Datenquellen.…”

Section: Gesundheitsökonomische Verfahrenunclassified

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DNVF-Memorandum Versorgungsforschung im letzten Lebensjahr

et al. 2022

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ZusammenfassungVersorgungsforschung im letzten Lebensjahr beschäftigt sich mit der wissenschaftlichen Erfassung der Begleitung und Betreuung von schwerstkranken und sterbenden Menschen sowie ihrer An- und Zugehörigen. Patientinnen und Patienten in der letzten Lebensphase können unterschiedlichen Erkrankungsgruppen angehören, besondere Charakteristika aufweisen (z. B. Menschen mit kognitiver und komplexer Beeinträchtigung, ökonomischer Benachteiligung oder Migrationshintergrund) sowie in bestimmten Lebensphasen sein (z. B. Eltern minderjähriger Kinder, (hohes) Alter). Aus der besonderen Situation der Betroffenen sowie aus den Besonderheiten der Versorgung im letzten Lebensjahr ergibt sich das Erfordernis für ein eigenes Memorandum zur Versorgungsforschung in dieser Lebensphase. Dieses Memorandum beschreibt diesbezüglich ethische und methodische Spezifika sowie aktuelle Fragestellungen der Versorgungsforschung und wie diese angemessen mittels quantitativer, qualitativer und gemischter Methoden bearbeitet werden können. Es wurde von der Fachgruppe Palliativmedizin des Deutschen Netzwerk für Versorgungsforschung e.V. (DNVF) entsprechend der Vorgaben für DNVF-Memoranden erarbeitet.

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“…Measuring the costs of palliative and end-of-life care is challenging but is important for the evaluation of different service delivery models [ 1 , 2 ]. Studies typically report that hospital stays and residential care represent the major cost of care, depending on the cause of death [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Adaptation of the Ambulatory and Home Care Record for collecting palliative care service utilisation data from family carers in the UK: a pilot study

Holdsworth

Gage

Williams

et al. 2018

Pilot Feasibility Stud

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BackgroundMeasuring service use and costs is an important aspect of service delivery evaluation. In end-of-life care, there is heavy reliance on care by family/friends (informal carers) and this should be reflected in the total cost of care alongside formal services. The Ambulatory and Home Care Record, developed in Canada, is both comprehensive in coverage and validated for collecting data on formal and informal caring. This study aimed to adapt and pilot the Ambulatory and Home Care Record questionnaire for use in the UK within a study evaluating a new palliative care service. The objectives were to test if family carers could be recruited and assess acceptability and usability of data gathered.MethodsSingle cohort pilot study using a structured telephone questionnaire carried out every other week. Family carers of patients newly added to the palliative care register or referred to hospice services in the South East of England were invited to participate by mail. Volunteers remained in the study for a maximum of six interviews or until the patient died.ResultsIn total, 194 carers were invited by mail to participate in the study, of which 23 (11.8%) completed at least one interview and 16 (8.2%) completed all possible interviews. Recruitment to the study was lower than anticipated, but most participants seemed to find the interviews acceptable. The modified questionnaire produced usable and relevant data for an economic evaluation of formal and informal caring costs.ConclusionsModifications are needed to the process of recruitment as a postal recruitment strategy did not have a high response rate. The Ambulatory and Home Care Record has proved a viable tool for use in the UK setting, with a few minor modifications, and will be used in a larger study comparing hospice models.Electronic supplementary materialThe online version of this article (10.1186/s40814-018-0332-2) contains supplementary material, which is available to authorized users.

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Current state of the economics of palliative and end-of-life care: A clinical view

Cited by 8 publications

References 12 publications

Impact of patient-centred and family-centred care meetings on intensive care and resource utilisation in patients with terminal illness: a single-centre retrospective observational study in Taiwan

Impact of patient-centred and family-centred care meetings on intensive care and resource utilisation in patients with terminal illness: a single-centre retrospective observational study in Taiwan

DNVF-Memorandum Versorgungsforschung im letzten Lebensjahr

Adaptation of the Ambulatory and Home Care Record for collecting palliative care service utilisation data from family carers in the UK: a pilot study

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