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Earlier palliative home care is associated with patient-centred medical resource utilisation and lower costs in the last 30 days before death in COPD: a population-level decedent cohort study

Charlotte Scheerens, Kristof Faes, Peter Pype, Kim Beernaert, Guy Joos, Eric Derom, Joachim Cohen, Luc Deliens, Kenneth Chambaere
European Respiratory Journal 2020 55: 1901139; DOI: 10.1183/13993003.01139-2019
Charlotte Scheerens
1End-of-Life Care Research Group, Ghent University, Ghent, Belgium
2End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
3Dept of Public Health and Primary Care, Ghent University, Ghent, Belgium
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  • For correspondence: charlotte.scheerens@ugent.be
Kristof Faes
1End-of-Life Care Research Group, Ghent University, Ghent, Belgium
2End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
3Dept of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Peter Pype
1End-of-Life Care Research Group, Ghent University, Ghent, Belgium
2End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
3Dept of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Kim Beernaert
1End-of-Life Care Research Group, Ghent University, Ghent, Belgium
2End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
3Dept of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Guy Joos
4Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
5Dept of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
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  • ORCID record for Guy Joos
Eric Derom
4Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
5Dept of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
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Joachim Cohen
1End-of-Life Care Research Group, Ghent University, Ghent, Belgium
2End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
6Dept of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Luc Deliens
1End-of-Life Care Research Group, Ghent University, Ghent, Belgium
2End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
3Dept of Public Health and Primary Care, Ghent University, Ghent, Belgium
6Dept of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
7Contributed equally as last author
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Kenneth Chambaere
1End-of-Life Care Research Group, Ghent University, Ghent, Belgium
2End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
3Dept of Public Health and Primary Care, Ghent University, Ghent, Belgium
7Contributed equally as last author
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Abstract

COPD patients often use many medical resources, such as hospital admissions and medical imaging, inappropriately close to death. Palliative home care (PHC) could beneficially affect this. The aim was to study the effect of use and timing of PHC on medical resource use and costs in the last 30 days before death (DBD) for COPD.

We performed a retrospective study of all Belgian decedents in 2010–2015 with COPD and a primary cause of death being COPD or cardiovascular diseases. Odds ratios for medical resources were calculated between using and four PHC timing categories (>360, 360–181, 180–91 and 90–31 DBD) versus not using. Confounders were socio-demographic, care intensity and disease severity variables.

Of the 58 527 decedents with COPD, 644 (1.1%) patients received PHC earlier than 30 DBD. Using PHC (versus not using) decreased the odds ratio for hospitalisation (0.35), intensive care unit admission (0.16), specialist contacts (0.58), invasive ventilation (0.13), medical imaging including chest radiograph (0.34), sedatives (0.48) and hospital death (0.14). It increased the odds ratio for home care (3.27), general practitioner contact (4.65), palliative care unit admission (2.61), noninvasive ventilation (2.65), gastric tube (2.15), oxygen (2.22) and opioids (4.04) (p<0.001). Mean total healthcare costs were €1569 lower for using PHC. All PHC timing categories showed a benefit in medical resource use and costs. However, we observed the largest benefit in the category PHC 90–31 DBD.

Health policy and services should focus on increasing PHC access, while research should further explore early PHC initiation for COPD.

Abstract

Palliative home care is associated with more patient-centred care and reduced costs in the final month of life for people with COPD http://bit.ly/2Pr2U1i

Footnotes

  • This article has supplementary material available from erj.ersjournals.com

  • Author contributions: Concept and idea of the study: C. Scheerens, K. Faes, K. Chambaere and J. Cohen. Data collection: K. Faes and J. Cohen. Data analysis: K. Faes, C. Scheerens and K. Chambaere. Data interpretation: K. Faes, C. Scheerens, K. Beernaert, K. Chambaere, L. Deliens, J. Cohen, P. Pype, G. Joos and E. Derom. Leading the writing of the paper: C. Scheerens and K. Chambaere. Critical revision: C. Scheerens, K. Beernaert, K. Chambaere, J. Cohen, L. Deliens, P. Pype, K. Faes, E. Derom and G. Joos. Read the final version: C. Scheerens, K. Beernaert, K. Chambaere, J. Cohen, P. Pype, L. Deliens, K. Faes, E. Derom and G. Joos.

  • Support statement: SBO IWT (number 140009) and Het Fonds Wetenschappelijk Onderzoek (FWO, Research Foundation-Flanders) (grant number G012414N) supported the funding of this study. K. Beernaert is a postdoctoral research fellow at FWO. Funding information for this article has been deposited with the Crossref Funder Registry.

  • Conflict of interest: C. Scheerens has nothing to disclose.

  • Conflict of interest: K. Faes has nothing to disclose.

  • Conflict of interest: P. Pype has nothing to disclose.

  • Conflict of interest: K. Beernaert has nothing to disclose.

  • Conflict of interest: G. Joos has nothing to disclose.

  • Conflict of interest: E. Derom has nothing to disclose.

  • Conflict of interest: J. Cohen has nothing to disclose.

  • Conflict of interest: L. Deliens has nothing to disclose.

  • Conflict of interest: K. Chambaere has nothing to disclose.

  • Received June 11, 2019.
  • Accepted February 14, 2020.
  • Copyright ©ERS 2020
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Earlier palliative home care is associated with patient-centred medical resource utilisation and lower costs in the last 30 days before death in COPD: a population-level decedent cohort study
Charlotte Scheerens, Kristof Faes, Peter Pype, Kim Beernaert, Guy Joos, Eric Derom, Joachim Cohen, Luc Deliens, Kenneth Chambaere
European Respiratory Journal May 2020, 55 (5) 1901139; DOI: 10.1183/13993003.01139-2019

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Earlier palliative home care is associated with patient-centred medical resource utilisation and lower costs in the last 30 days before death in COPD: a population-level decedent cohort study
Charlotte Scheerens, Kristof Faes, Peter Pype, Kim Beernaert, Guy Joos, Eric Derom, Joachim Cohen, Luc Deliens, Kenneth Chambaere
European Respiratory Journal May 2020, 55 (5) 1901139; DOI: 10.1183/13993003.01139-2019
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