National policies fostering hospice care increased hospice utilization and reduced the invasiveness of end-of-life care for cancer patients
Journal
Oncologist
Journal Volume
22
Journal Issue
7
Pages
843-849
Date Issued
2017
Author(s)
Abstract
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.
Other Subjects
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
Publisher
AlphaMed Press
Type
journal article