Noncancer hospice care in Taiwan: A nationwide dataset analysis from 2005 to 2010

Shih Chao Kang, Fu Tzu Pai, Shinn Jang Hwang, Hsiao Mei Tsao, Der Ming Liou, I. Feng Lin

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: The National Health Insurance program (NHI) in Taiwan has provided hospice services since 2000, and it was expanded to noncancer illnesses in September 2009. The issues of noncancer hospice care and the impact of the expanded hospice policy remain unclear. Methods: Data were collected retrospectively from claims data of hospice admissions using the NHI Research Database of 2005-2010. Results: A total of 359 noncancer subjects and 412 hospice admissions were enrolled; 1795 age-and gender-matched cancer patients and 2578 hospice admissions were selected as a comparison group. Noncancer hospice care increased markedly after the third quartile of 2009. The most common noncancer diagnosis was "other diseases of the lung" (23.9%). The noncancer subjects had a significantly lower frequency of admissions, lower Charlson Comorbidity Index (CCI) scores, shorter hospice stay, and higher mortality rate than the cancer subjects. Family physicians provided the majority of hospice services in both groups. Acute low respiratory conditions (ALRC) were the most common acute comorbidity in deceased subjects. The noncancer decedents had more ALRC, sepsis/bacteremia, nontraumatic shock, acute myocardial infarctions, and esophageal varicose bleeding than the comparison group. The mean inpatient charges differed insignificantly between both groups. The noncancer subjects correlated negatively with CCI (odds ratio [OR] 0.59 in all hospice admissions; 0.63 in decedents), but positively with a hospice stay ≤3 days, mortality, sepsis/bacteremia, ALRC, nontraumatic shock, and acute myocardial infarctions compared with the cancer subjects (OR 1.42, 1.98, 2.24, 2.36, 2.17, and 11.68, respectively, adjusted by CCI). Conclusions: The expanded palliative care policy has impacted positively on noncancer hospice care in Taiwan. The terminal noncancer patients had higher risks for short hospice stay, sepsis, nontraumatic shock, and respiratory and heart problems than the cancer subjects. Early referral to hospices is required for terminal patients in Taiwan. The CCI had a limited role for cost/severity evaluations of hospice care.

Original languageEnglish
Pages (from-to)407-414
Number of pages8
JournalJournal of Palliative Medicine
Volume17
Issue number4
DOIs
Publication statusPublished - Apr 1 2014
Externally publishedYes

Fingerprint

Hospice Care
Hospices
Taiwan
National Health Programs
Comorbidity
Shock
Sepsis
Bacteremia
Datasets
Odds Ratio
Myocardial Infarction
Neoplasms
Heart Neoplasms
Mortality
Family Physicians
Palliative Care
Lung Diseases
Inpatients
Referral and Consultation

ASJC Scopus subject areas

  • Nursing(all)
  • Anesthesiology and Pain Medicine

Cite this

Noncancer hospice care in Taiwan : A nationwide dataset analysis from 2005 to 2010. / Kang, Shih Chao; Pai, Fu Tzu; Hwang, Shinn Jang; Tsao, Hsiao Mei; Liou, Der Ming; Lin, I. Feng.

In: Journal of Palliative Medicine, Vol. 17, No. 4, 01.04.2014, p. 407-414.

Research output: Contribution to journalArticle

Kang, Shih Chao ; Pai, Fu Tzu ; Hwang, Shinn Jang ; Tsao, Hsiao Mei ; Liou, Der Ming ; Lin, I. Feng. / Noncancer hospice care in Taiwan : A nationwide dataset analysis from 2005 to 2010. In: Journal of Palliative Medicine. 2014 ; Vol. 17, No. 4. pp. 407-414.
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abstract = "Background: The National Health Insurance program (NHI) in Taiwan has provided hospice services since 2000, and it was expanded to noncancer illnesses in September 2009. The issues of noncancer hospice care and the impact of the expanded hospice policy remain unclear. Methods: Data were collected retrospectively from claims data of hospice admissions using the NHI Research Database of 2005-2010. Results: A total of 359 noncancer subjects and 412 hospice admissions were enrolled; 1795 age-and gender-matched cancer patients and 2578 hospice admissions were selected as a comparison group. Noncancer hospice care increased markedly after the third quartile of 2009. The most common noncancer diagnosis was {"}other diseases of the lung{"} (23.9{\%}). The noncancer subjects had a significantly lower frequency of admissions, lower Charlson Comorbidity Index (CCI) scores, shorter hospice stay, and higher mortality rate than the cancer subjects. Family physicians provided the majority of hospice services in both groups. Acute low respiratory conditions (ALRC) were the most common acute comorbidity in deceased subjects. The noncancer decedents had more ALRC, sepsis/bacteremia, nontraumatic shock, acute myocardial infarctions, and esophageal varicose bleeding than the comparison group. The mean inpatient charges differed insignificantly between both groups. The noncancer subjects correlated negatively with CCI (odds ratio [OR] 0.59 in all hospice admissions; 0.63 in decedents), but positively with a hospice stay ≤3 days, mortality, sepsis/bacteremia, ALRC, nontraumatic shock, and acute myocardial infarctions compared with the cancer subjects (OR 1.42, 1.98, 2.24, 2.36, 2.17, and 11.68, respectively, adjusted by CCI). Conclusions: The expanded palliative care policy has impacted positively on noncancer hospice care in Taiwan. The terminal noncancer patients had higher risks for short hospice stay, sepsis, nontraumatic shock, and respiratory and heart problems than the cancer subjects. Early referral to hospices is required for terminal patients in Taiwan. The CCI had a limited role for cost/severity evaluations of hospice care.",
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T1 - Noncancer hospice care in Taiwan

T2 - A nationwide dataset analysis from 2005 to 2010

AU - Kang, Shih Chao

AU - Pai, Fu Tzu

AU - Hwang, Shinn Jang

AU - Tsao, Hsiao Mei

AU - Liou, Der Ming

AU - Lin, I. Feng

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N2 - Background: The National Health Insurance program (NHI) in Taiwan has provided hospice services since 2000, and it was expanded to noncancer illnesses in September 2009. The issues of noncancer hospice care and the impact of the expanded hospice policy remain unclear. Methods: Data were collected retrospectively from claims data of hospice admissions using the NHI Research Database of 2005-2010. Results: A total of 359 noncancer subjects and 412 hospice admissions were enrolled; 1795 age-and gender-matched cancer patients and 2578 hospice admissions were selected as a comparison group. Noncancer hospice care increased markedly after the third quartile of 2009. The most common noncancer diagnosis was "other diseases of the lung" (23.9%). The noncancer subjects had a significantly lower frequency of admissions, lower Charlson Comorbidity Index (CCI) scores, shorter hospice stay, and higher mortality rate than the cancer subjects. Family physicians provided the majority of hospice services in both groups. Acute low respiratory conditions (ALRC) were the most common acute comorbidity in deceased subjects. The noncancer decedents had more ALRC, sepsis/bacteremia, nontraumatic shock, acute myocardial infarctions, and esophageal varicose bleeding than the comparison group. The mean inpatient charges differed insignificantly between both groups. The noncancer subjects correlated negatively with CCI (odds ratio [OR] 0.59 in all hospice admissions; 0.63 in decedents), but positively with a hospice stay ≤3 days, mortality, sepsis/bacteremia, ALRC, nontraumatic shock, and acute myocardial infarctions compared with the cancer subjects (OR 1.42, 1.98, 2.24, 2.36, 2.17, and 11.68, respectively, adjusted by CCI). Conclusions: The expanded palliative care policy has impacted positively on noncancer hospice care in Taiwan. The terminal noncancer patients had higher risks for short hospice stay, sepsis, nontraumatic shock, and respiratory and heart problems than the cancer subjects. Early referral to hospices is required for terminal patients in Taiwan. The CCI had a limited role for cost/severity evaluations of hospice care.

AB - Background: The National Health Insurance program (NHI) in Taiwan has provided hospice services since 2000, and it was expanded to noncancer illnesses in September 2009. The issues of noncancer hospice care and the impact of the expanded hospice policy remain unclear. Methods: Data were collected retrospectively from claims data of hospice admissions using the NHI Research Database of 2005-2010. Results: A total of 359 noncancer subjects and 412 hospice admissions were enrolled; 1795 age-and gender-matched cancer patients and 2578 hospice admissions were selected as a comparison group. Noncancer hospice care increased markedly after the third quartile of 2009. The most common noncancer diagnosis was "other diseases of the lung" (23.9%). The noncancer subjects had a significantly lower frequency of admissions, lower Charlson Comorbidity Index (CCI) scores, shorter hospice stay, and higher mortality rate than the cancer subjects. Family physicians provided the majority of hospice services in both groups. Acute low respiratory conditions (ALRC) were the most common acute comorbidity in deceased subjects. The noncancer decedents had more ALRC, sepsis/bacteremia, nontraumatic shock, acute myocardial infarctions, and esophageal varicose bleeding than the comparison group. The mean inpatient charges differed insignificantly between both groups. The noncancer subjects correlated negatively with CCI (odds ratio [OR] 0.59 in all hospice admissions; 0.63 in decedents), but positively with a hospice stay ≤3 days, mortality, sepsis/bacteremia, ALRC, nontraumatic shock, and acute myocardial infarctions compared with the cancer subjects (OR 1.42, 1.98, 2.24, 2.36, 2.17, and 11.68, respectively, adjusted by CCI). Conclusions: The expanded palliative care policy has impacted positively on noncancer hospice care in Taiwan. The terminal noncancer patients had higher risks for short hospice stay, sepsis, nontraumatic shock, and respiratory and heart problems than the cancer subjects. Early referral to hospices is required for terminal patients in Taiwan. The CCI had a limited role for cost/severity evaluations of hospice care.

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