This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Abstract
BACKGROUND: Numerous studies have demonstrated that hospice palliative care interventions for cancer patients can reduce health care utilzation. In Taiwan, 20–25% of patients who require mechanical ventilation are using prolonged mechanical ventilation (PMV); however, only a limited number of studies have addressed the effectiveness of hospice palliative care for these patients. This study investigated the impact of hospice palliative care utilization on medical utilization among subjects using PMV.
METHODS: By using the health insurance database of a nationwide population-based study, we identified subjects who had been on mechanical ventilation for > 21 d, were age ≥18 y between 2009 and 2017, and had received hospice palliative care. The control group was formed through 1:1 matching by using propensity scoring after excluding patients who had participated in palliative care for <15 d or for >181 d. Furthermore, we used a conditional logistic regression analysis to investigate the incidence of ICU admission, emergency department presentation, and cardiopulmonary resuscitation within 14 d before death.
RESULTS: A total of 186,533 new subjects receiving PMV age ≥ 18 y were admitted between 2009 and 2017. In addition, the number of subjects receiving palliative care increased annually, rising from 0.6% in 2009 to 41.33% in 2017. The emergency department visits (odds ratio [OR] 0.68, 95% CI 0.63–0.74), ICU admission (OR 0.59, 95% CI 0.53–0.66), cardiopulmonary resuscitation (OR 0.40, 95% CI 0.35–0.46), and total hospitalization cost ($1,319.91 ± $1,821.66 versus $1,544.37 ± $2,309.27 [$USD], P < .001) were significant lower in the palliative care group.
CONCLUSIONS: Subjects undergoing PMV while receiving hospice palliative care experienced significant reductions in total hospitalization costs, ICU admissions, cardiopulmonary resuscitation, and medical expenses within 14 d before death.
Footnotes
- Correspondence: Wen-Chen Tsai DrPH, Department of Health Services Administration, China Medical University, no. 100 Section 1 Jingmao Road, Beitun District, Taichung, Taiwan 40402, R.O.C. E-mail: wtsai{at}mail.cmu.edu.tw
The authors have disclosed no conflicts of interest.
We had access to the whole population database of national health insurance in Taichung, Taiwan, after approved by the National Health Research Institutes.
A version of this paper was presented by Chin-Jung Liu, Chia-Chen Chu, Yeong Ruey Chu, Wen-Chen Tsai at AARC Congress 2021, held virtually December 9 to 12, 2021.
Data are available from the National Health Insurance Research Database published and managed by the Ministry of Health and Welfare, Taiwan. Due to legal restrictions imposed by the Taiwan government related to the Personal Information Protection Act, these databases cannot be made publicly available. This study was approved by the Clinical Trial/Human Research Committee Review of the Research Ethics Committee of China Medical University Hospitals (CMUH108-REC2-129).
This study used databases, including the National Health Insurance Research Database and the Cause of Death File. All researchers can apply for using the databases for conducting their studies. Requests for using data can be sent as a formal proposal to the Science Center of the Ministry of Health and Welfare (https://www.mohw.gov.tw/mp-2.html). Any raw data are not allowed to be brought out from the Science Center. Only the analytic outputs in format of table or figure can be printed out. The restrictions prohibited the authors from making the minimal data set publicly available.
- Copyright © 2024 by Daedalus Enterprises
Pay Per Article - You may access this article (from the computer you are currently using) for 1 day for US$30.00
Regain Access - You can regain access to a recent Pay per Article purchase if your access period has not yet expired.
