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. 2017 Jul;22(7):843-849.
doi: 10.1634/theoncologist.2016-0367. Epub 2017 Apr 13.

National Policies Fostering Hospice Care Increased Hospice Utilization and Reduced the Invasiveness of End-of-Life Care for Cancer Patients

Yu-Yun Shao  1   2   3 , Emily Han-Chung Hsiue  1 , Chih-Hung Hsu  1   2 , Chien-An Yao  4 , Ho-Min Chen  1 , Mei-Shu Lai  5   6 , Ann-Lii Cheng  7   2   8   3
Affiliations

National Policies Fostering Hospice Care Increased Hospice Utilization and Reduced the Invasiveness of End-of-Life Care for Cancer Patients

Yu-Yun Shao et al. Oncologist. 2017 Jul.

Abstract
in English, Chinese

Background: In 2011, two national policies aiming to foster hospice services for terminal cancer patients took effect in Taiwan. The single-payer National Health Insurance of Taiwan started to reimburse full hospice services. The national hospital accreditation program, which graded all hospitals, incorporated hospice utilization in its evaluation. We assessed the impact of these national policies.

Methods: A cohort of 249,394 patients aged ≥18 years who died of cancer between 2008 and 2013 were identified from the National Death Registry. We retrieved utilization data of medical services and compared the health care utilization in the final month of life before and after the implementation of the new policies.

Results: After the policy changes, hospice utilization increased from 20.8% to 36.2%. In a multivariate analysis adjusting for patient demographics, cancer features, and hospital characteristics, hospice utilization significantly increased after 2011 (adjusted odds ratio [AOR] 2.35, p < .001), accompanied by a decrease in intensive care unit (ICU) admissions, invasive mechanical ventilation (IMV), and cardiopulmonary resuscitation (CPR; AORs 0.87, 0.75, and 0.80, respectively; all p < .001). The patients who received hospice services were significantly less likely to receive ICU admissions, IMV, and CPR (AORs 0.20, 0.12, and 0.10, respectively; all p < .001). Hospice utilization was associated with an adjusted net savings of U.S. $696.90 (25.2%, p < .001) per patient in the final month of life.

Conclusion: The national policy changes fostering hospice care significantly increased hospice utilization, decreased invasive end-of-life care, and reduced the medical costs of terminal cancer patients.

Implications for practice: National policies fostering hospice care significantly increased hospice utilization, decreased invasive end-of-life care, and reduced the medical costs of terminal cancer patients.

摘要

背景. 台湾当局于2011年出台了两项政策, 旨在面向癌症晚期患者推行临终关怀服务。采用单一支付制度的台湾全民健康保险已开始全额报销临终关怀服务的相关费用。台湾医院认证项目旨在评定所有医院的等级, 其评价项目中也纳入了临终关怀的利用情况。我们评估了上述政策带来的影响。

方法. 我们查阅了台湾死亡登记处的资料, 从中发现249 394例在2008‐2013年期间死于癌症的≥18岁患者。我们还检索了医疗服务利用数据, 并比较了新政策实施前后患者在生命最后一个月内的医疗资源利用情况。

结果. 政策变更后, 临终关怀利用率从20.8%增至36.2%。在一项多变量分析中, 调整患者人口统计学、癌症特征和医院特征后, 结果显示2011年后临终关怀利用率显著增加[调整比值比（AOR）2.35, p <0.001], 与此同时, 进入重症监护室（ICU）、行有创机械通气（IMV）和行心肺复苏（CPR）的患者有所减少（AOR分别为0.87、0.75和0.80；所有 p <0.001）。接受临终关怀服务的患者进入ICU、行IMV和行CPR的可能性显著降低（AOR分别为0.20、0.12和0.10；所有p<0.001）。临终关怀利用使每例患者在生命最后一个月内的调整后费用净减少696.90美元（25.2%, p <0.001）。

结论. 台湾当局关于推行临终关怀的政策变更显著增加了癌症晚期患者的临终关怀利用率, 减少了侵入性临终诊治, 并降低了医疗费用。

Keywords: Cost; End‐of life care; Hospice; Policy.

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Conflict of interest statement

Disclosures of potential conflicts of interest may be found at the end of this article.

Figures

Figure 1.
Figure 1.
Health care utilization in the final month of life from 2008 to 2013. (A): Hospice and invasive EOL care services. (B): Indicators of aggressive EOL care. Abbreviations: CPR, cardiopulmonary resuscitation; EOL, end‐of‐life; HD, hemodialysis; ICU, intensive care unit .
Figure 2.
Figure 2.
Hospice utilization in the final month of life from 2008 to 2013, by patients’ gender (A), age (B), cancer origin (C), and number of comorbidities (D).
Figure 3.
Figure 3.
Annual total NHI expenditure, EOL care costs, and the proportion of EOL care costs relative to the total NHI expenditure for cancer decedents from 2008 to 2013. Abbreviations: EOL, end‐of‐life; NHI, National Health Insurance; USD, U.S. dollars.
See this image and copyright information in PMC

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