https://scholars.lib.ntu.edu.tw/handle/123456789/484063
標題: | National policies fostering hospice care increased hospice utilization and reduced the invasiveness of end-of-life care for cancer patients | 作者: | YU-YUN SHAO Hsiue E.H.-C. CHIH-HUNG HSU CHIEN-AN YAO Chen H.-M. Lai M.-S. ANN-LII CHENG |
公開日期: | 2017 | 出版社: | AlphaMed Press | 卷: | 22 | 期: | 7 | 起(迄)頁: | 843-849 | 來源出版物: | Oncologist | 摘要: | Background. In 2011, two national policies aiming to foster hospice services for terminal cancer patients took effect in Taiwan. The single-payer National Health Insurance of Taiwan started to reimburse full hospice services. The national hospital accreditation program, which graded all hospitals, incorporated hospice utilization in its evaluation. We assessed the impact of these national policies. Methods. A cohort of 249,394 patients aged ?18 years who died of cancer between 2008 and 2013 were identified from the National Death Registry. We retrieved utilization data of medical services and compared the health care utilization in the final month of life before and after the implementation of the new policies. Results. After the policy changes, hospice utilization increased from 20.8% to 36.2%. In a multivariate analysis adjusting for patient demographics, cancer features, and hospital characteristics, hospice utilization significantly increased after 2011 (adjusted odds ratio [AOR] 2.35, p<.001), accompanied by a decrease in intensive care unit (ICU) admissions, invasive mechanical ventilation (IMV), and cardiopulmonary resuscitation (CPR; AORs 0.87, 0.75, and 0.80, respectively; all p<.001). The patients who received hospice services were significantly less likely to receive ICU admissions, IMV, and CPR (AORs 0.20, 0.12, and 0.10, respectively; all p <.001). Hospice utilization was associated with an adjusted net savings of U.S. 696.90 (25.2%, p<.001) per patient in the finalmonth of life. Conclusion. The national policy changes fostering hospice care significantly increased hospice utilization, decreased invasive end-of-life care, and reduced the medical costs of terminal cancer patients. ? AlphaMed Press. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-85024133399&doi=10.1634%2ftheoncologist.2016-0367&partnerID=40&md5=0f92b4f8a77f5c39f88a6327e0eb8a46 https://scholars.lib.ntu.edu.tw/handle/123456789/484063 |
ISSN: | 1083-7159 | DOI: | 10.1634/theoncologist.2016-0367 | SDG/關鍵字: | aged; Article; artificial ventilation; cancer chemotherapy; cancer mortality; cancer patient; colon cancer; comorbidity; cost benefit analysis; female; foster care; head and neck cancer; health care policy; health care utilization; hemodialysis; hospice care; hospital admission; hospitalization; human; liver cancer; lung cancer; major clinical study; male; malignant neoplasm; priority journal; rectum cancer; resuscitation; stomach cancer; hospice; hospice care; middle aged; neoplasm; procedures; statistics and numerical data; Taiwan; terminal care; utilization; very elderly; Aged; Aged, 80 and over; Female; Hospice Care; Hospices; Hospitalization; Humans; Male; Middle Aged; Neoplasms; Taiwan; Terminal Care |
顯示於: | 腫瘤醫學研究所 |
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