Potentially inappropriate end of life care and healthcare costs in the last 30 days of life in regions providing integrated palliative care in the Netherlands : a registration-based study

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PEREIRA, Chantal F. R. | DIJXHOORN, Anne-Floor Q. | KOEKOEK, Berdine | VAN DEN BROEK, Monique | VAN DER STEEN, Karin | ENGEL, Marijanne | VAN RIJN, Marjon | MEIJERS, Judith M. | HASSELAAR, Jeroen | VAN DER HEIDE, Agnes | ONWUTEAKA-PHILIPSEN, Bregje D. | VAN DEN BEUKEN-VAN EVERDINGEN, Marieke H. J. | VAN DER LINDEN, Yvette M. | BODDAERT, Manon S. | JEURISSEN, Patrick P. T. | MERKX, Matthias A. W. | RAIJMAKERS, Natasja J. H.

INTRODUCTION: This study aimed to assess the effect of integrated palliative care (IPC) on potentially inappropriate end- of-life care and healthcare-costs in the last 30 days of life in the Netherlands. METHODS: Nationwide health-insurance claims data were used to assess potentially inappropriate end-of-life care (=2 emergency room visits; =2 hospital admissions; >14 days hospitalization; chemotherapy; ICU admission; hospital death) and healthcare-costs in all deceased adults in IPC regions pre- and post- implementation and in those receiving IPC compared to a 1:2 matched control group. RESULTS: In regions providing IPC deceased adults (n = 37,468) received significantly less potentially inappropriate end-of-life care post-implementation compared to pre-implementation (26.5% vs 27.9%; p < 0.05). Deceased adults who received IPC (n = 210) also received significantly less potentially inappropriate end-of-life care compared to a matched control group (14.8% vs 28.3%; p < 0.05). Mean hospital costs significantly decreased for deceased adults who received IPC (€2,817), while mean costs increased for general practitioner services (€311) and home care (€1,632). DISCUSSION: These results highlight the importance of implementation of integrated palliative care and suitable payment. Further research in a larger sample is needed. CONCLUSION: This study shows less potentially inappropriate end-of-life care and a shift in healthcare costs from hospital to general practitioner and home care with IPC.

http://dx.doi.org/10.5334/ijic.7504

Voir la revue «International Journal of Integrated Care, 24»

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