Abstract
Background: A number of studies have shown that hospice palliative care intervention in the cancer patients can reduce medical utilization. In Taiwan we have 20-25% prolonged mechanical ventilation population, only little research discussing the effectiveness of hospice palliative care in patients who prolonged mechanical ventilation. The purpose of this study was to explore the interest of patients undergoing PMV in hospice palliative care as the effectiveness on medical utilization.
Methods: This was a population-based retrospective matched cohort study. This study used the Taiwan Health Insurance whole population database to analyze data of patients undergoing PMV whose ages were ≥ 18 y from 2009 to 2017. Our aim was to analyze the rate at which patients undergoing PMV elected to join the hospice Palliative Care Program of the National Health Insurance and the impact of the program on related factors. The control group was obtained by 1:1 matching using propensity scoring after excluding patients who participated in palliative care > 181 d or < 15 d. We also sought to compare utilization of intensive care and emergency care before 14 days of death between those who accepted hospice palliative care and those who did not. Furthermore, we used conditional logistic regression analysis to explore ICU readmission, emergency department presentation, and cardiopulmonary resuscitation incidence.
Results: The number of prolonged mechanical ventilation of the emergency visits (odds ratio [OR] = 0.68, 95% CI: 0.63–0.74), ICU hospitalization (OR = 0.59, 95% CI: 0.53–0.46), and cardiopulmonary resuscitation (OR = 0.40, 95% CI: 0.35–0.46) was lower in the palliative care group.
Conclusions: Patients undergoing PMV participating in hospice palliative care can significantly reduce ICU admittance, cardiopulmonary resuscitation utilization, and medical expenses at ≤14 d before death.
Footnotes
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