Abstract
ObjectiveTo examine the regional variation in hospital care utilization in the last 6 months of life of Dutch patients with lung cancer and to test whether higher degrees of hospital utilization coincide with less general practitioner (GP) and long-term care use.DesignCross-sectional claims data study.SettingThe Netherlands.ParticipantsPatients deceased in 2013–2015 with lung cancer (N = 25 553).Main Outcome MeasuresWe calculated regional medical practice variation scores, adjusted for age, gender and socioeconomic status, for radiotherapy, chemotherapy, CT-scans, emergency room contacts and hospital admission days during the last 6 months of life; Spearman Rank correlation coefficients measured the association between the adjusted regional medical practice variation scores for hospital admissions and ER contacts and GP and long-term care utilization.ResultsThe utilization of hospital services in high-using regions is 2.3–3.6 times higher than in low-using regions. The variation was highest in 2015 and lowest in 2013. For all 3 years, hospital care was not significantly correlated with out-of-hospital care at a regional level.ConclusionsHospital care utilization during the last 6 months of life of patients with lung cancer shows regional medical practice variation over the course of multiple years and seems to increase. Higher healthcare utilization in hospitals does not seem to be associated with less intensive GP and long-term care. In-depth research is needed to explore the causes of the variation and its relation to quality of care provided at the level of daily practice.
Highlights
Often, care for patients near the End-of-Life (EOL) does not meet the desires of patients or their families [1] and pro-active palliative care is not provided on time [2]
The patient characteristics did not differ between the years
With 335.5, the absolute difference was largest for emergency room (ER)-contacts
Summary
Care for patients near the End-of-Life (EOL) does not meet the desires of patients or their families [1] and pro-active palliative care is not provided on time [2]. Lung cancer (LC) is a common cancer type with high hospital care costs, and patients are very likely to undergo aggressive treatments [9]. They are heavy users of acute care beds and the emergency room (ER) at the EOL [9,10], both indicators of poor-quality care [10]. Utilization of palliative consultations was low (3%) [-Reference blinded for review], even though it is known that early palliative care can optimize the quality of EOL care [11,12] and the treatment decision ‘potentially curative/life-prolonging treatment’ was more often described as inappropriate (35%) than appropriate (8%) [13]
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