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Transition between care settings at end of life in the Netherlands: results from a nationwide study.
Abarshi, E., Echteld, M., Block, L. van den, Donker, G., Deliens, L., Onwuteaka-Philipsen, B. Transition between care settings at end of life in the Netherlands: results from a nationwide study. European Journal of Public Health: 2009, 19(Suppl.1), p. 55. Abstract. 17th European Public Health Conference 'Human Ecology and Public Health', 25–28 November 2009, Lodz (Polen).
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Issue/problem: Transitions between care settings at the end of life could hinder continuity of care for the terminally ill, suggesting a low quality of end-of-life care. Aim: To examine the nature and prevalence of care setting transitions in the last 3 months of life in the Netherlands, and to identify potential characteristics associated with them. Methods: Between January 2005 and December 2006, we performed a mortality follow-back study on all non-sudden deaths for patients aged >1 year. Data were collected via the Dutch Sentinel Network General Practitioners (GPs), an existing health surveillance network representative of all GPs in the Netherlands. A care setting transition was defined as a change in setting of care. Results: During the 2-year period we studied 690 patients whose deaths were ‘totally expected and non-sudden’. In the last 3 months of life, 43 distinct care trajectories and 709 transitions were identified (involving a hospital 2/3 of times). The most frequent trajectory was home-hospital (48%). Forty-six percent experienced >1 transition in their last month of life. Being male, multi-morbidity, and absent GP-awareness of a patient’s preferred place of death were associated with having a transition in the last 30 days; whereas being <85 years, having an infection and absent palliative-centred treatment goal were associated with terminal hospitalization for >7 days. Lessons: Although majority of non-sudden deaths occur at home, transitions to hospitals are relatively frequent. To minimize unnecessary or unwanted transitions, timely recognition of the palliative phase of dying is important.(aut. ref.)
Issue/problem: Transitions between care settings at the end of life could hinder continuity of care for the terminally ill, suggesting a low quality of end-of-life care. Aim: To examine the nature and prevalence of care setting transitions in the last 3 months of life in the Netherlands, and to identify potential characteristics associated with them. Methods: Between January 2005 and December 2006, we performed a mortality follow-back study on all non-sudden deaths for patients aged >1 year. Data were collected via the Dutch Sentinel Network General Practitioners (GPs), an existing health surveillance network representative of all GPs in the Netherlands. A care setting transition was defined as a change in setting of care. Results: During the 2-year period we studied 690 patients whose deaths were ‘totally expected and non-sudden’. In the last 3 months of life, 43 distinct care trajectories and 709 transitions were identified (involving a hospital 2/3 of times). The most frequent trajectory was home-hospital (48%). Forty-six percent experienced >1 transition in their last month of life. Being male, multi-morbidity, and absent GP-awareness of a patient’s preferred place of death were associated with having a transition in the last 30 days; whereas being <85 years, having an infection and absent palliative-centred treatment goal were associated with terminal hospitalization for >7 days. Lessons: Although majority of non-sudden deaths occur at home, transitions to hospitals are relatively frequent. To minimize unnecessary or unwanted transitions, timely recognition of the palliative phase of dying is important.(aut. ref.)
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