Appropriate Timing of End-of-Life Care: A Dutch Policy Analysis and Opportunities for Improvement.

Autor:	Jansen WJJ; Dept. Anesthesiology, Amsterdam UMC, Amsterdam, Netherlands., Lerou JGC; Dept. Anesthesiology, Amsterdam UMC, Amsterdam, Netherlands., Schober PR; Dept. Anesthesiology, Amsterdam UMC, Amsterdam, Netherlands., Szadek KM; Dept. Anesthesiology, Amsterdam UMC, Amsterdam, Netherlands., Huisman BAA; Dept. Anesthesiology, Amsterdam UMC, Amsterdam, Netherlands.; Hospice Kuria, Amsterdam, the Netherlands., Steegers MAH; Dept. Anesthesiology, Amsterdam UMC, Amsterdam, Netherlands.
Jazyk:	angličtina
Zdroj:	Palliative medicine reports [Palliat Med Rep] 2024 Jul 19; Vol. 5 (1), pp. 269-277. Date of Electronic Publication: 2024 Jul 19 (Print Publication: 2024).
DOI:	10.1089/pmr.2023.0087
Abstrakt:	Background: The Exceptional Medical Expenses Act (EMEA) guaranteed public financing for the costs of end-of-life care in The Netherlands until 2015. A life expectancy shorter than three months was a prerequisite for a patient to qualify. Objective: To estimate survival and its potential predictors using the start date of EMEA funded end-of-life care as time origin, and to calculate the ensuing costs. Design: Retrospective observational study using data retrieved from multiple datasets of the national statistical office Statistics Netherlands (https://www.cbs.nl/en-gb/). Setting: Included were all adult patients, who received EMEA funded end-of-life care in hospice units in nursing homes and homes for the elderly in The Netherlands between January 1, 2009, and December 31, 2014. Results: In 40,659 patients (median age 79 years), the distribution of survival was extremely skewed. Median, 95%, and maximum survival times were 15 (95% confidence interval [CI] = 15-15), 219 (210-226), and 2,006 days, respectively. The 90-day and 180-day survival rates were 12.4 (12.1-12.7)% and 6.2 (6.0-6.5)%, respectively. Although age, gender, diagnosis, and start year of end-of-life care were statistically significant independent predictors, clinical significance is limited. End-of-life care was delivered for a total of 1,720,002 days, costing almost 440 million Euros. Fifty-nine percent of the costs was for barely 11% of patients, i.e., those who received end-of-life care for more than 90 days. Conclusion: The use of life expectancy is a weak basis for the appropriate timing of end-of-life care. Further research should evaluate potential tools to improve the timing of end-of-life care, while using available resources efficiently. (© Wim J. J. Jansen et al., 2024; Published by Mary Ann Liebert, Inc.)
Databáze:	MEDLINE
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