What happens at the end of life? Using linked administrative health data to understand healthcare usage in the last year of life in New Zealand

Hamblin, Richard; Minko, Nikolai; Shuker, Carl; Hill, Jennifer; Merry, Alan

doi:10.1016/j.healthpol.2018.05.011

Cited by 5 publications

(5 citation statements)

References 31 publications

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“…Policymakers endorse the wider application of existing administrative data as a time and cost-effective means to inform policy development and practice (Lyon et al, 2015). Administrative data collected by criminal justice, health and social services is used globally to understand trends in populations and evaluate interventions (Gibbs and Wildfire, 2007;Hamblin et al, 2018;Bailey et al, 2020). Large, multi-level administrative datasets enable researchers to develop and test increasingly complex conceptualisations of violence, its precursors and outcomes, and can be linked to data from other agencies (Hurren et al, 2017).…”

Section: Challenges In Using Administrative Datamentioning

confidence: 99%

Challenges of using specialist domestic and sexual violence and abuse service data to inform policy and practice on violence reduction in the UK

Bunce,

Smith,

Carlisle

et al. 2024

Journal of Gender-Based Violence

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Specialist domestic and sexual violence and abuse support services routinely collect administrative data about victim-survivors’ experiences of violence, interventions, and individual- and service-level outcomes. When used effectively, such information has the potential to enhance understanding of patterns of violence in society and ensure that responses are evidence-based. However, the extent to which insights from specialist services’ administrative data can inform policy and practice on violence reduction is limited by three interrelated challenges: different approaches to the measurement of violence and abuse; the issue of disproportionate funding and capacity of services, and the practicalities of multi-agency working. This article contributes to a gap in knowledge by explicitly addressing the challenges of using such data. It is hoped that it will encourage further discussions into how services collect and use data, which would greatly enhance knowledge in this area. To gain a more accurate picture of violence and abuse, their consequent harms in society, and where resources and interventions should be targeted, it is vital that specialist services data is integrated with other sources of data on violence.

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Section: Challenges In Using Administrative Datamentioning

confidence: 99%

Challenges of using specialist domestic and sexual violence and abuse service data to inform policy and practice on violence reduction in the UK

Bunce,

Smith,

Carlisle

et al. 2024

Journal of Gender-Based Violence

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“…People coded as enrolled had at least one active enrolment status during the study period; those coded as not enrolled had no active enrolment status or no record in the PHO dataset. The literature reports that the use of PHC services changes towards the end of life [13]. As a sensitivity analysis, we explored differences in the pattern of PHO enrolment and mortality outcomes when the enrolment status in the year of death is specified.…”

Section: Enrolment Statusmentioning

confidence: 99%

Association between enrolment with a Primary Health Care provider and amenable mortality: A national population-based analysis in Aotearoa New Zealand

et al. 2023

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Introduction In Aotearoa New Zealand, being enrolled with a Primary Health Care (PHC) provider furnishes opportunities for lower cost access to PHC, preventative care and secondary health care services, and provides better continuity of care. We examine the characteristics of populations not enrolled, and whether enrolment is associated with amenable mortality. Method We retrieved records of all deaths registered 2008 to 2017 in Aotearoa New Zealand, which included demographic and primary cause of death information. Deaths were classified as premature (aged under 75 years) or not, and amenable to health care intervention or not. The Primary Health Organisation (PHO) Enrolment Collection dataset provided the PHC enrolment status. Logistic regression was used to estimate the risk of amenable deaths by PHO enrolment status, adjusted for the effects of age, sex, ethnicity and deprivation. Results A total of 308,628 mortality records were available. Of these, 38.2% were premature deaths, and among them 47.8% were amenable deaths. Cardiovascular diseases made up almost half of the amenable deaths. Males, youths aged 15–24 years, Pacific peoples, Māori and those living in the most socio-economically deprived areas demonstrated a higher risk of amenable mortality compared to their respective reference category. One in twenty (4.3%) people who had died had no active enrolment status in any of the calendar years in the study. The adjusted odds of amenable mortality among those not enrolled in a PHO was 39% higher than those enrolled [Odds Ratio = 1.39, 95% Confidence Interval 1.30–1.47]. Implications Being enrolled in a PHC system is associated with a lower level of amenable mortality. Given demonstrated inequities in enrolment levels across age and ethnic groups, efforts to improve this could have significant benefits on health equity.

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“…The goal of the first sub-study was to analyse the costs of care associated with the care in the last year of life for older aged citizens. The last months of life are among the most expensive in persons' life (Hogan et al, 2001;Polder, Barendregt and Van Oers, 2006;Hanratty et al, 2007;Riley and Lubitz, 2010;Blakely et al, 2014;Tanuseputro et al, 2015;Hamblin et al, 2018). However, the results have been seemingly incongruous on whether the older age of dying is related with higher or lower social and health care costs.…”

Section: Context and Aimsmentioning

confidence: 99%

Early Start of Anti-Dementia Medication Delays Transition to 24-Hour Care in Alzheimer’s Disease Patients: A Finnish Nationwide Cohort Study

Halminen

Vesikansa²,

Mehtälä³

et al. 2021

JAD

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Background: Dementia is one of the strongest predictors of admission to a 24-hour care facility among older people, and 24-hour care is the major cost of Alzheimer’s disease (AD). Objective: The aim of this study was to evaluate the association of early start of anti-dementia medication and other predisposing factors with 2-year risk of transition to 24-hour care in the nationwide cohort of Finnish AD patients. Methods: This was a retrospective, non-interventional study based on individual-level data from Finnish national health and social care registers. The incident cohort included 7,454 AD patients (ICD-10, G30) comprised of two subgroups: those living unassisted at home (n = 5,002), and those receiving professional home care (n = 2,452). The primary outcome was admission to a 24-hour care facility. Exploratory variables were early versus late anti-dementia medication start, sociodemographic variables, care intensity level, and comorbidities. Results: Early anti-dementia medication reduced the risk of admission to 24-hour care both in patients living unassisted at home, with a hazard ratio (HR) of 0.58 (p < 0.001), and those receiving professional home care (HR, 0.84; p = 0.039). Being unmarried (HR, 1.69; p < 0.001), having an informal caregiver (HR, 1.69; p = 0.003), or having a diagnosis of additional neurological disorder (HR, 1.68; p = 0.006) or hip fracture (HR, 1.61; p = 0.004) were associated with higher risk of admission to 24-hour care in patients living unassisted at home. Conclusion: To support living at home, early start of anti-dementia medication should be a high priority in newly diagnosed AD patients.

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What happens at the end of life? Using linked administrative health data to understand healthcare usage in the last year of life in New Zealand

Cited by 5 publications

References 31 publications

Challenges of using specialist domestic and sexual violence and abuse service data to inform policy and practice on violence reduction in the UK

Challenges of using specialist domestic and sexual violence and abuse service data to inform policy and practice on violence reduction in the UK

Association between enrolment with a Primary Health Care provider and amenable mortality: A national population-based analysis in Aotearoa New Zealand

Early Start of Anti-Dementia Medication Delays Transition to 24-Hour Care in Alzheimer’s Disease Patients: A Finnish Nationwide Cohort Study

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