Abstract
BackgroundThe provision and quality of end-of-life care (EoLC) in Germany is inconsistent. Therefore, an evaluation of current EoLC based on quality indicators is needed. This study aims to evaluate EoLC in Germany on the basis of quality indicators pertaining to curative overtreatment, palliative undertreatment and delayed palliative care (PC). Results were compared with previous findings.MethodsData from a statutory health insurance provider (AOK Lower Saxony) pertaining to deceased members in the years 2016 and 2017 were used to evaluate EoLC. The main indicators were: chemotherapy for cancer patients in the last month of life, first-time percutaneous endoscopic gastrostomy (PEG) for patients with dementia in the last 3 months of life, number of hospitalisations and days spent in inpatient treatment in the last 6 months of life, and provision of generalist and specialist outpatient PC in the last year of life. Data were analysed descriptively.ResultsData for 64,275 deceased members (54.3% female; 35.1% cancer patients) were analysed. With respect to curative overtreatment, 10.4% of the deceased with cancer underwent chemotherapy in the last month and 0.9% with dementia had a new PEG insertion in the last 3 months of life. The mean number of hospitalisations and inpatient treatment days per deceased member was 1.6 and 16.5, respectively, in the last 6 months of life. Concerning palliative undertreatment, generalist outpatient PC was provided for 28.0% and specialist outpatient PC was provided for 9.0% of the deceased. Regarding indicators for delayed PC, the median onset of generalist and specialist outpatient PC was 47.0 and 24.0 days before death, respectively.ConclusionCompared to data from 2010 to 2014, the data analysed in the present study suggest an ongoing curative overtreatment in terms of chemotherapy and hospitalisation, a reduction in new PEG insertions and an increase in specialist PC. The number of patients receiving generalist PC remained low, with delayed onset. Greater awareness of generalist PC and the early integration of PC are recommended.Trial registrationThe study was registered in the German Clinical Trials Register (DRKS00015108; 22 January 2019).
Highlights
The provision and quality of end-of-life care (EoLC) in Germany is inconsistent
Palliative undertreatment Compared to the results of Radbruch et al, the present findings showed a reduction in palliative undertreatment for specialist outpatient palliative care (PC), but a consistent level of generalist outpatient PC, and ongoing palliative undertreatment [7]
In addition to finding a decrease in new percutaneous endoscopic gastrostomy (PEG) insertions and an increase in specialist outpatient PC at the end of life, the present study showed an ongoing pattern of curative overtreatment, palliative undertreatment and delayed provision of generalist PC
Summary
The provision and quality of end-of-life care (EoLC) in Germany is inconsistent. This study aims to evaluate EoLC in Germany on the basis of quality indicators pertaining to curative overtreatment, palliative undertreatment and delayed palliative care (PC). In Germany, outpatient PC includes both generalist and specialist PC. Generalist PC for patients in the community is mostly initiated and provided by primary care professionals (most frequently general practitioners). It is intended for patients at an early stage in their disease trajectory with overall low symptom intensity [10]. Since 2013, generalist outpatient PC in Germany has been available for statutory health insurance billing [11]. Specialist outpatient PC is governed by the 2007 German Act to Strengthen Competition in statutory health insurance, and can be prescribed by both outpatient and inpatient physicians [12]
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