Care utilization patterns among patients dying with advanced chronic obstructive pulmonary disease

Abstract

BACKGROUND: Patients with advanced chronic obstructive pulmonary disease (ACOPD) may see different medical specialists in the last year of life. OBJECTIVE: The objective of this study was to describe outpatient care patterns during the last year of life for patients with ACOPD and how this relates to acute care visitation and the location of death. METHODS: A retrospective cohort study of patients with ACOPD who died between 2017 and 2019 in Ontario, Canada, using linked health administrative data was conducted. Patients were classified into mutually exclusive groups based on physician care patterns to identify trends in inpatient utilization. RESULTS: Patients (N = 34,837) median age at death was 78 years, 53% were male, and 84% resided in urban regions. Five outpatient encounter patterns emerged: (i) primary care, palliative care and relevant specialists to ACOPD (41%); (ii) primary care and relevant specialists (36%); (iii) primary care only led (15%); (iv) palliative care and relevant specialists (7%); and v) no outpatient encounters. All groups had a high proportion of outpatient encounters with primary care or palliative care specialists as well as high rates of hospitalizations and emergency department visits among all patients. CONCLUSIONS: Patients with ACOPD predominantly receive primary care in their last year of life. Acute care utilization also varied between those receiving palliative care versus none, with higher rates being reported by patients that had no palliative care involvement. Future research should explore associations between the continuity of care among these different healthcare professionals in relation to end of life outcomes.

RÉSUMÉ Contexte Les patients souffrant de maladie pulmonaire obstructive chronique (MPOC) à un stade avancé peuvent être amenés à consulter différents spécialistes au cours de la dernière année de leur vie.

Objectif Décrire les schémas de soins ambulatoires au cours de la dernière année de vie des patients atteints de MPOC avancée, ainsi que leur lien avec la fréquentation des services de soins aigus et le lieu du décès.

Méthodes Étude de cohorte rétrospective portant sur des patients atteints de MPOC avancée, décédés entre 2017 et 2019 en Ontario, au Canada, en s’appuyant sur des données administratives de santé liées. Les patients ont été classés en groupes mutuellement exclusifs selon les schémas de soins médicaux, afin de déterminer les tendances en matière d'utilisation des soins hospitaliers.

Résultats Parmi les patients (N = 34 837), l’âge médian au décès était de 78 ans, 53 % étaient des hommes et 84 % résidaient en milieu urbain. Cinq schémas de consultations externes sont apparus : (i) soins