Background Tan Tock Seng Hospital’s (TTSH’s) Home Ventilation and Respiratory Support Service (HVRSS) has managed patients with chronic, progressive neurological diseases requiring home ventilation support since 2009. We examined patients’ healthcare utilisation [hospital admissions, cumulative length of stay (LOS), HVRSS home visits], 3 months prior-to-death; and investigated associations with having completed Advanced Care Plans (ACPs). We hypothesised that patients with and without ACPs potentially have differences in end-of-life healthcare utilisation outcomes.
Methods This was a retrospective cohort study. Patients were deceased by 2019, had ≥1 HVRSS encounter and sufficient electronic medical documentation. Data was either recorded by TTSH HVRSS/ACP teams, or extracted by the research team. The factor of having completed ACPs (with and without) was incorporated into regression analysis of outcomes.
Results Among 118 patients, 75 (63.6%) were male and mostly Chinese (84.7%). Mean HVRSS enrolment-age was 64.2 years (SD=16.1), and duration was 1.8 years (SD=1.8). Main diagnoses were Motor Neuron Disease (47.5%), Neuromuscular Disease (12.7%) and Spinal Cord Injury (13.6%). Fifty-two (44.1%) had ACPs, with more being doctor-facilitated discussions (67.3%). Most discussions were conducted with patient and family (46.2%); followed by patient only (36.5%), then without patients (17.3%). Mean ACP-to-death duration was 1.6 years (SD=1.6).
Compared to patients without ACP, the cumulative hospital LOS in the 3 months prior-to-death was lower individuals with a completed ACP [ACP: mean=5.8, SD=11.0; No ACP: mean=14.9, SD=25.3; (IRR: 0.39–0.43; p<0.001)]. However, the number of home care visits were higher for those with completed ACPs [ACP: mean=5.3, SD=4.4; No ACP: mean=4.0; SD=4.2; (IRR=1.29–1.32; 0.001<p<0.004)]. No significant between-group differences in hospitalisation were detected (0.777<p<0.931).
Conclusions HVRSS home visits appeared to have supported end-of-life care for those with completed ACP and therefore, may have reduced hospital LOS at end-of-life. ACPs can potentially be an important service-planning consideration for home ventilation patients.
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