Tracking hospital costs in the last year of life ― The Shanghai experience

Zhu, Bifan; Li, Fen; Wang, Changying; Wang, Linan; He, Zhimin; Zhang, Xiaoxi; Song, Peipei; Ding, Lingling; Jin, Chunlin

doi:10.5582/bst.2017.01245

Cited by 11 publications

(7 citation statements)

References 23 publications

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“…There was higher healthcare utilisation in the young-old despite the lack of difference in functional status and frailty between the two groups, although prevalence of dementia was non-significantly higher in the old-old group. This has been observed in previous studies [ 31 , 32 ]. Specifically, our old-old had less days spent in hospital during their last year of life, fewer number of hospital admissions, clinic visits and lower prevalence of polypharmacy.…”

Section: Discussionsupporting

confidence: 89%

Healthcare utilisation in the last year of life in internal medicine, young-old versus old-old

Chen

et al. 2020

BMC Geriatr

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Background With increasing cost of healthcare in our aging society, a consistent pain point is that of end-of-life care. It is particularly difficult to prognosticate in non-cancer patients, leading to more healthcare utilisation without improving quality of life. Additionally, older adults do not age homogenously. Hence, we seek to characterise healthcare utilisation in young-old and old-old at the end-of-life. Methods We conducted a single-site retrospective review of decedents under department of Advanced Internal Medicine (AIM) over a year. Young-old is defined as 65–79 years; old-old as 80 years and above. Data collected was demographic characteristics; clinical data including Charlson Comorbidity Index (CCI), FRAIL-NH and advance care planning (ACP); healthcare utilisation including days spent in hospital, hospital admissions, length of stay of terminal admission and clinic visits; and quality of end-of-life care including investigations and symptomatic control. Documentation was individually reviewed for quality of communication. Results One hundred eighty-nine older adult decedents. Old-old decedents were mostly females (63% vs. 42%, p = 0.004), higher CCI scores (7.7 vs 6.6, p = 0.007), similarly frail with lower polypharmacy (62.9% vs 71.9%, p = 0.01). ACP uptake was low in both, old-old 15.9% vs. young-old 17.5%. Poor prognosis was conveyed to family, though conversation did not result in moderating extent of care. Old-old had less healthcare utilisation. Adjusting for sex, multimorbidity and frailty, old-old decedents had 7.3 ± 3.5 less hospital days in their final year. Further adjusting for cognition and residence, old-old had 0.5 ± 0.3 less hospital admissions. When accounted for home care services, old-old spent 2.7 ± 0.8 less hospital days in their last admission. Conclusion There was high healthcare utilisation in older adults, but especially young-old. Enhanced education and goal-setting are needed in the acute care setting. ACP needs to be reinforced in acute care with further research to evaluate if it reduces unnecessary utilisation at end-of-life.

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Section: Discussionsupporting

confidence: 89%

Healthcare utilisation in the last year of life in internal medicine, young-old versus old-old

Chen

et al. 2020

BMC Geriatr

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“…In addition to the accumulation of incidence of autoimmune [ 40 ], cancer [ 41 ], and dementia [ 42 ] morbidity among elderly citizens, here we face another important phenomenon. It is the so-called “the last year of life” [ 43 ]. Its costs of intensive, palliative, and home-based medical care, requiring nursing staff, due to the gradual disappearance of family caregiving across Asia [ 44 ], generates costs that are, on average, equal to the entire life-time medical consumption of that individual citizen.…”

Section: Discussionmentioning

confidence: 99%

Real GDP growth rates and healthcare spending – comparison between the G7 and the EM7 countries

et al. 2020

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Background: Accelerated globalisation has substantially contributed to the rise of emerging markets worldwide. The G7 and Emerging Markets Seven (EM7) behaved in significantly different macroeconomic ways before, during, and after the 2008 Global Crisis. Average real GDP growth rates remained substantially higher among the EM7, while unemployment rates changed their patterns after the crisis. Since 2017, however, approximately one half of the worldwide economic growth is attributable to the EM7, and only a quarter to the G7. This paper aims to analyse the association between the health spending and real GDP growth in the G7 and the EM7 countries. Results: In terms of GDP growth, the EM7 exhibited a higher degree of resilience during the 2008 crisis, compared to the G7. Unemployment in the G7 nations was rising significantly, compared to pre-recession levels, but, in the EM7, it remained traditionally high. In the G7, the austerity (measured as a percentage of GDP) significantly decreased the public health expenditure, even more so than in the EM7. Out-of-pocket health expenditure grew at a far more concerning pace in the EM7 compared to the G7 during the crisis, exposing the vulnerability of households living close to the poverty line. Regression analysis demonstrated that, in the G7, real GDP growth had a positive impact on out-of-pocket expenditure, measured as a percentage of current health expenditure, expressed as a percentage of GDP (CHE). In the EM7, it negatively affected CHE, CHE per capita, and out-of-pocket expenditure per capita. Conclusion: The EM7 countries demonstrated stronger endurance, withstanding the consequences of the crisis as compared to the G7 economies. Evidence of this was most visible in real growth and unemployment rates, before, during and after the crisis. It influenced health spending patterns in both groups, although they tended to diverge instead of converge in several important areas.

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“…There are more studies on symptoms in recent years, such as pain, delirium and fatigue, but the absolute number is still small. We can also see research about survival prediction, advance care planning, palliative medicine teaching, grief, dignity therapy, end-stage patient care model, patient and family care needs, costs, [5][6][7] DNR (Do Not Resuscitate), 8 the role of traditional Chinese medicine, 9 survival prediction tools and policy.…”

Section: Hospice and Palliative Care Research In Mainland China: Currmentioning

confidence: 99%

Hospice and palliative care research in mainland China: Current status and future direction

Xia¹

2019

Palliat Med

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Tracking hospital costs in the last year of life ― The Shanghai experience

Cited by 11 publications

References 23 publications

Healthcare utilisation in the last year of life in internal medicine, young-old versus old-old

Healthcare utilisation in the last year of life in internal medicine, young-old versus old-old

Real GDP growth rates and healthcare spending – comparison between the G7 and the EM7 countries

Hospice and palliative care research in mainland China: Current status and future direction

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