Hospice utilization during the SARS outbreak in Taiwan

Abstract

Background: The severe acute respiratory syndrome (SARS) epidemic threw the world into turmoil during the first half of 2003. Many subsequent papers have addressed its impact on health service utilization, but few have considered palliative (hospice) care. The aim of the present study was to describe changes in hospice inpatient utilization during and after the SARS epidemic in 2003 in Taiwan.

Methods: The data sources were the complete datasets of inpatient admissions during 2002 and 2003 from the National Health Insurance Research Database. Before-and-after comparisons of daily and monthly utilizations were made. Hospice analyses were limited to those wards that offered inpatient services throughout these two years. The comparisons were extended to total hospital bed utilization and to patients who were still admitted to hospice wards during the peak period of the SARS epidemic.

Results: Only 15 hospice wards operated throughout the whole of 2002 and 2003. In 2003, hospice utilization began to decrease in the middle of April, reached a minimum on 25 May, and gradually recovered to the level of the previous November. Hospices showed a more marked reduction in utilization than all hospital beds (e.g. -52.5% vs. -19.9% in May 2003) and a slower recovery with a three-month lag. In total, 566 patients were admitted to hospice wards in May/June 2003, in contrast to 818 in May/June 2002. Gender, age and diagnosis distributions did not differ.

Conclusion: Hospice inpatient utilization in Taiwan was indeed more sensitive to the emerging epidemic than general inpatient utilization. A well-balanced network with seamless continuity of care should be ensured.

Figure 1

Number of patients per day in 15 hospice wards during 2002 (non-SARS year) and 2003 (SARS year).

Figure 2

Differences between aggregate patient-days of hospice beds and all kinds of hospital beds in 15 hospitals during each month of 2003 compared with the corresponding months of 2002. Difference = ((patient-days in a month of 2003) – (patient-days in a month of 2002))/(patient-days in a month of 2002).

Figure 3

Differences between aggregate patient-days in hospice wards during each month of 2003 and those of the corresponding months of 2002, stratified by accreditation level. Difference = ((patient-days in a month of 2003) – (patient-days in a month of 2002))/(patient-days in a month of 2002).

Figure 4

Differences between aggregate patient-days in hospice wards during each month of 2003 and those of the corresponding months of 2002, stratified by geographic location. Difference = ((patient-days in a month of 2003) – (patient-days in a month of 2002))/(patient-days in a month of 2002).