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Article: End-of-life care in cancer and dementia: a nationwide population-based study of palliative care policy changes

TitleEnd-of-life care in cancer and dementia: a nationwide population-based study of palliative care policy changes
Authors
Keywordscancer
Dementia
end-of-life
palliative care
Issue Date2019
PublisherBMJ Group. The Journal's web site is located at http://spcare.bmj.com/
Citation
BMJ Supportive & Palliative Care, 2019, Epub 2019-09-17 How to Cite?
AbstractObjectives: The National Health Insurance programme started providing coverage for inpatient care in palliative care (PC) units of acute care hospitals in 2000; however, initially, only PC provided to patients with terminal cancer was covered. A PC policy that enabled PC reimbursement for patients with dementia was implemented in 2009. However, the association of this PC policy with end-of-life care remains unclear. The study aims to compare the association of the PC policy with end-of-life care between patients with dementia and patients with cancer during the last 6 months of their lives. Methods: We analysed the claims data of 7396 patients dying with dementia (PDD) and 24 319 patients dying with cancer (PDC) during 1997–2013. Results: Among PDC, while the percentage of receiving PC increased from 3.6% in 1999 to 14.2% by the end of 2000 (adjusted OR (aOR)=4.07, 95% CI 2.70 to 6.13) and from 20.9% in 2010 to 41.0% in 2013 (aOR=1.40, 95% CI 1.33 to 1.47), vasopressor use decreased from 71.6% in 1999 to 35.5% in 2001 (aOR=0.90, 95% CI 0.82 to 0.98). Among PDD, PC use increased from 0.2% in 2009 to 4.9% in 2013 (aOR=2.05, 95% CI 1.60 to 2.63) and cardiopulmonary resuscitation use decreased from 17.6% in 2009 to 10.0% in 2013 (aOR=0.83, 95% CI 0.76 to 0.90). Conclusions: Implementation of the PC policy in Taiwan was associated with improved PC utilisation among patients with cancer and dementia, which may reduce unnecessary medical care procedures.
Persistent Identifierhttp://hdl.handle.net/10722/277373
ISSN
2021 Impact Factor: 4.633
2020 SCImago Journal Rankings: 0.779

 

DC FieldValueLanguage
dc.contributor.authorKuo, LC-
dc.contributor.authorLee, JJ-
dc.contributor.authorCheung, DST-
dc.contributor.authorChen, PJ-
dc.contributor.authorLin, C-C-
dc.date.accessioned2019-09-20T08:49:50Z-
dc.date.available2019-09-20T08:49:50Z-
dc.date.issued2019-
dc.identifier.citationBMJ Supportive & Palliative Care, 2019, Epub 2019-09-17-
dc.identifier.issn2045-435X-
dc.identifier.urihttp://hdl.handle.net/10722/277373-
dc.description.abstractObjectives: The National Health Insurance programme started providing coverage for inpatient care in palliative care (PC) units of acute care hospitals in 2000; however, initially, only PC provided to patients with terminal cancer was covered. A PC policy that enabled PC reimbursement for patients with dementia was implemented in 2009. However, the association of this PC policy with end-of-life care remains unclear. The study aims to compare the association of the PC policy with end-of-life care between patients with dementia and patients with cancer during the last 6 months of their lives. Methods: We analysed the claims data of 7396 patients dying with dementia (PDD) and 24 319 patients dying with cancer (PDC) during 1997–2013. Results: Among PDC, while the percentage of receiving PC increased from 3.6% in 1999 to 14.2% by the end of 2000 (adjusted OR (aOR)=4.07, 95% CI 2.70 to 6.13) and from 20.9% in 2010 to 41.0% in 2013 (aOR=1.40, 95% CI 1.33 to 1.47), vasopressor use decreased from 71.6% in 1999 to 35.5% in 2001 (aOR=0.90, 95% CI 0.82 to 0.98). Among PDD, PC use increased from 0.2% in 2009 to 4.9% in 2013 (aOR=2.05, 95% CI 1.60 to 2.63) and cardiopulmonary resuscitation use decreased from 17.6% in 2009 to 10.0% in 2013 (aOR=0.83, 95% CI 0.76 to 0.90). Conclusions: Implementation of the PC policy in Taiwan was associated with improved PC utilisation among patients with cancer and dementia, which may reduce unnecessary medical care procedures.-
dc.languageeng-
dc.publisherBMJ Group. The Journal's web site is located at http://spcare.bmj.com/-
dc.relation.ispartofBMJ Supportive & Palliative Care-
dc.rightsBMJ Supportive & Palliative Care. Copyright © BMJ Group.-
dc.rightsThis article has been accepted for publication in [Journal, Year] following peer review, and the Version of Record can be accessed online at [insert full DOI eg. http://dx.doi.org/10.1136/xxxxx]. [© Authors (or their employer(s)) OR © BMJ Publishing Group Ltd ( for assignments of BMJ Case Reports)] <year>-
dc.subjectcancer-
dc.subjectDementia-
dc.subjectend-of-life-
dc.subjectpalliative care-
dc.titleEnd-of-life care in cancer and dementia: a nationwide population-based study of palliative care policy changes-
dc.typeArticle-
dc.identifier.emailLee, JJ: leejay@hku.hk-
dc.identifier.emailCheung, DST: denisest@hku.hk-
dc.identifier.emailLin, C-C: cclin@hku.hk-
dc.identifier.authorityLee, JJ=rp02239-
dc.identifier.authorityCheung, DST=rp02526-
dc.identifier.authorityLin, C-C=rp02265-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1136/bmjspcare-2019-001782-
dc.identifier.scopuseid_2-s2.0-85072538546-
dc.identifier.hkuros305486-
dc.identifier.hkuros314292-
dc.publisher.placeUnited Kingdom-
dc.identifier.issnl2045-435X-

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