TY - JOUR

T1 - Healthcare utilisation trajectories in patients dying from chronic obstructive pulmonary disease, heart failure or cancer

T2 - a nationwide register-based cohort study

AU - Vestergaard, Anne Høy Seemann

AU - Christiansen, Christian Fynbo

AU - Neergaard, Mette Asbjoern

AU - Valentin, Jan Brink

AU - Johnsen, Søren Paaske

N1 - © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2021/11

Y1 - 2021/11

N2 - OBJECTIVES: To investigate illness trajectories as reflected by healthcare utilisation, including hospital and intensive care unit admissions, consultations in general practice and home care provision, before death comparing people dying from chronic obstructive pulmonary disease (COPD), heart failure and cancer.DESIGN: Nationwide register-based cohort study.SETTING: Data on all hospital admissions, including intensive care unit admissions, consultations in general practice and home care provision were obtained from nationwide Danish registries.PARTICIPANTS: All adult decedents in Denmark dying from COPD, heart failure or cancer between 2006 and 2016.OUTCOME MEASURES: For each day within 5 years before death, we computed a daily prevalence proportion (PP) of being admitted to hospital or consulting a general practitioner. For each day within 6 months before death, we computed PPs of being admitted to intensive care or receiving home care. The PPs were plotted and compared by regression analyses adjusting for age, gender, comorbidity level, marital/cohabitation status, municipality and income level.RESULTS: Among 1 74 086 patients dying from COPD (n=22 648), heart failure (n=11 498) or cancer (n=139 940), the PPs of being admitted to hospital or consulting a general practitioner showed similar steady progression and steep increase in the last year of life for all patient populations. The PP of being admitted to intensive care showed modest increase during the last 6 months of life, accelerating in the last month, for all patient populations. For patients with COPD and heart failure, the PP of receiving home care remained stable during the last 6 months of life but increased steadily for patients with cancer.CONCLUSION: We found limited differences in healthcare resource utilisation at the end of life for people with COPD, heart failure or cancer, indicating comparable illness trajectories.This supports the need to reconsider efforts in achieving equal access to palliative care interventions, which is still mainly offered to patients with cancer.

AB - OBJECTIVES: To investigate illness trajectories as reflected by healthcare utilisation, including hospital and intensive care unit admissions, consultations in general practice and home care provision, before death comparing people dying from chronic obstructive pulmonary disease (COPD), heart failure and cancer.DESIGN: Nationwide register-based cohort study.SETTING: Data on all hospital admissions, including intensive care unit admissions, consultations in general practice and home care provision were obtained from nationwide Danish registries.PARTICIPANTS: All adult decedents in Denmark dying from COPD, heart failure or cancer between 2006 and 2016.OUTCOME MEASURES: For each day within 5 years before death, we computed a daily prevalence proportion (PP) of being admitted to hospital or consulting a general practitioner. For each day within 6 months before death, we computed PPs of being admitted to intensive care or receiving home care. The PPs were plotted and compared by regression analyses adjusting for age, gender, comorbidity level, marital/cohabitation status, municipality and income level.RESULTS: Among 1 74 086 patients dying from COPD (n=22 648), heart failure (n=11 498) or cancer (n=139 940), the PPs of being admitted to hospital or consulting a general practitioner showed similar steady progression and steep increase in the last year of life for all patient populations. The PP of being admitted to intensive care showed modest increase during the last 6 months of life, accelerating in the last month, for all patient populations. For patients with COPD and heart failure, the PP of receiving home care remained stable during the last 6 months of life but increased steadily for patients with cancer.CONCLUSION: We found limited differences in healthcare resource utilisation at the end of life for people with COPD, heart failure or cancer, indicating comparable illness trajectories.This supports the need to reconsider efforts in achieving equal access to palliative care interventions, which is still mainly offered to patients with cancer.

KW - adult palliative care

KW - internal medicine

KW - oncology

KW - quality in health care

U2 - 10.1136/bmjopen-2021-049661

DO - 10.1136/bmjopen-2021-049661

M3 - Journal article

C2 - 34819282

VL - 11

JO - B M J Open

JF - B M J Open

SN - 2044-6055

IS - 11

M1 - 049661

ER -