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

Lou Ching Kuo, Jung Jae Lee, Denise Shuk Ting Cheung, Ping Jen Chen, Chia Chin Lin

Research output: Contribution to journalArticle

Abstract

Objectives: 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.

Original languageEnglish
JournalBMJ Supportive and Palliative Care
DOIs
Publication statusPublished - Sep 17 2019

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Terminal Care
Palliative Care
Dementia
Population
Neoplasms
National Health Programs
Cardiopulmonary Resuscitation
Taiwan
Inpatients

Keywords

  • cancer
  • Dementia
  • end-of-life
  • palliative care

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Oncology(nursing)
  • Medical–Surgical

Cite this

End-of-life care in cancer and dementia : A nationwide population-based study of palliative care policy changes. / Kuo, Lou Ching; Lee, Jung Jae; Cheung, Denise Shuk Ting; Chen, Ping Jen; Lin, Chia Chin.

In: BMJ Supportive and Palliative Care, 17.09.2019.

Research output: Contribution to journalArticle

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abstract = "Objectives: 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.",
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T2 - A nationwide population-based study of palliative care policy changes

AU - Kuo, Lou Ching

AU - Lee, Jung Jae

AU - Cheung, Denise Shuk Ting

AU - Chen, Ping Jen

AU - Lin, Chia Chin

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AB - Objectives: 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.

KW - cancer

KW - Dementia

KW - end-of-life

KW - palliative care

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