Impact of patient-centred and family-centred care meetings on intensive care and resource utilisation in patients with terminal illness: A single-centre retrospective observational study in Taiwan
Journal
BMJ Open
Journal Volume
9
Journal Issue
2
Date Issued
2019
Author(s)
Abstract
Objective Shared decision making is essential for patients and their families when facing serious and life-threatening diseases. This study aimed to evaluate the impact of patient-centred and family-centred care meetings (PFCCM) on intensive measures and resource utilisation during end-of-life (EOL) hospitalisation among terminally ill patients. Design and setting A retrospective cross-sectional study using electronic medical records was conducted in a tertiary referral medical centre in Taiwan. Participants We identified 6843 deceased patients with terminal illness who either received or did not receive PFCCM during EOL hospitalisation between January 2013 and December 2015. Primary and secondary outcome measures Patients who were transferred to the intensive care unit (ICU). Those who underwent invasive or non-invasive mechanical ventilation, tracheostomy, haemodialysis and surgical intervention during the final hospitalisation were determined by the use of intensive care measures; secondary measures were individual total and daily medical expenditures. A generalised estimating equation (GEE) model was used to compare the differences between the two groups. OR and beta coefficients (β) with 95% CI were estimated. Results This study identified 459 patients (6.7%) who received PFCCM during EOL hospitalisation. Multivariate analyses showed that patients who received PFCCM were less likely to have ICU admissions (OR 0.44, 95% CI 0.34 to 0.57), undergo surgical interventions (OR 0.74, 95% CI 0.58 to 0.95) and invasive mechanical ventilation (OR 0.50, 95% CI 0.38 to 0.66) during the final hospitalisation, after adjusting for patient demographics, clinical conditions and year of admission. Additionally, a significant decrease in daily medical expenditures was observed in PFCCM patients (β-0.18, 95% CI-0.25 to-0.12) than in non-PFCCM patients. Conclusions Patient-physician discussion through PFCCM is associated with less intensive care utilisation and daily medical expenditure during EOL hospitalisation in terminally ill patients. ? 2019 Author(s).
SDGs
Other Subjects
adult; aged; Article; artificial ventilation; clinical evaluation; confidence interval; controlled study; correlation analysis; cross-sectional study; demography; doctor patient relationship; electronic medical record; family centered care; female; generalized estimating equation; health care cost; health care utilization; hemodialysis; human; intensive care; intensive care unit; major clinical study; male; mathematical model; multivariate analysis; noninvasive ventilation; observational study; outcome assessment; patient care; retrospective study; shared decision making; surgical patient; terminal disease; terminally ill patient; tertiary health care; tracheostomy; adolescent; economics; health care planning; hospitalization; intensive care; middle aged; patient care; procedures; regression analysis; Taiwan; terminal care; young adult; Adolescent; Adult; Aged; Critical Care; Cross-Sectional Studies; Decision Making, Shared; Female; Health Expenditures; Health Resources; Hospitalization; Humans; Intensive Care Units; Male; Middle Aged; Multivariate Analysis; Patient-Centered Care; Physician-Patient Relations; Regression Analysis; Retrospective Studies; Taiwan; Terminal Care; Young Adult
Publisher
BMJ Publishing Group
Type
journal article