Developing an operational typology of patients hospitalised in palliative care units

Abstract

The objective of this study was to develop an operational typology of patients hospitalised in palliative care units (PC units) and to characterize these populations. Prospective data were collected in four PC units over three-week periods, generating a sample of 139 cases. Five classes of patient were identified and described via a factorial analysis and a classification: metastatic cancers requiring significant psychological attention, terminally ill patients, ENT cancers, neurological diseases and elderly patients. A more detailed study revealed differences between metastatic cancers, younger patients, very dependent patients and the other patients. We present the sociodemographic, clinical and cost per patient profiles of each class of patient. Having access to a broader sample of PC units and of patients would allow for a more complete typology.

Determinants of resource utilization in four palliative care units

“…We refer the reader to two articles for more information on our sample. 51,52 Full cost per patient/day The full cost per patient/day was, on average, t4349/73. The lowest cost was t301 and the maximum was t667 ( Table 1).…”

“…But, it soon appeared that the variables used as explanatory factors were highly correlated with one another, so that a stable and robust model must be defined. In addition, we observed (from interviews carried out with caregivers and from a preliminary analysis of the data), 51,52 that the studied population is not homogeneous, neither at the clinical level, nor from an economic point of view. We thus decided to focus on less classic, but more relevant methods for our research:…”

“…50 A model of standard costs per stay is in the process of being developed. If the strictly clinical aspects of the stays can be parameterized, on the other hand, two issues need to be addressed: (1) the patients involved with PC require much counselling and psychosocial care and the duration of this care varies on a case-bycase basis; 51,52 how, therefore, does one take into account this dimension in the definition of normalized costs? ; (2) we noted an important variability of the lengths of stay (which led us to analyse costs/day, and not costs/stay); is it then better to consider a model which remains based on complete stays, or on the contrary, to adopt a model of reimbursement based on the days of hospitalization?…”

How much does care in palliative care wards cost in Poland?

“…Therefore, the authors of this study propose introducing the diagnosis-related group (DRG) system components widely used in the ‘acute’ hospital wards to the heterogeneous population of terminally ill patients. Charging for the entire stay of the patient in the ward may pose another model of funding [ 27 , 30 ]. In France, the highest reimbursement for hospitalization is obtained for the stay of a patient at a specialist PCU.…”

What Is Palliative Care Performed in Certified Palliative Care Units in Japan?

“…1--3 Some countries are trying to develop a case-mix classification to fulfill each patient's needs. 4,5 To clarify what treatments are currently provided in palliative care units in Japan, we surveyed all 132 certified members of The Japanese Association of Hospice and Palliative Care Units. We sent an anonymous questionnaire by mail in June 2004, and the representative physicians of each hospital were requested to report the frequency of each treatment performed on a Likert-type scale from ''not at all'' to ''very often.''…”