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Variations in hospital inpatient palliative care service use: a retrospective cohort study
  1. Hassan Assareh1,
  2. Joanne M Stubbs1,
  3. Lieu T T Trinh1,
  4. Sally Greenaway2,
  5. Meera Agar3,4 and
  6. Helen M Achat1
  1. 1 Epidemiology and Health Analytics, Western Sydney Local Health District, North Parramatta, New South Wales, Australia
  2. 2 Western Sydney Local Health District, Westmead Hospital, Westmead, New South Wales, Australia
  3. 3 South Western Sydney Local Health District, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
  4. 4 Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Hassan Assareh, Epidemiology and Health Analytics, Western Sydney Local Health District, North Parramatta, NSW 2151, Australia; Hassan.Assareh{at}


Objective Use of palliative care in hospitals for people at end of life varies. We examined rate and time of in-hospital palliative care use and associated interhospital variations.

Methods We used admissions from all hospitals in New South Wales, Australia, within a 12-month period, for a cohort of adults who died in 73 public acute care hospitals between July 2010 and June 2014. Receiving palliative care and its timing were based on recorded use.

Results Among 90 696 adults who died, 27% received palliative care, and the care was initiated 7.6 days (mean; SD: 3.3 days) before death. Over the 5-year period, the palliative care rate rose by 58%, varying extent across chronic conditions. The duration of palliative care before death declined by 7%. Patient (demographics, morbidities and service use) and hospital factors (size, location and availability of palliative care unit) explained half of the interhospital variation in outcomes: adjusted IQR in rate and duration of palliative care among hospitals were 23%–39% and 5.2–8.7 days, respectively. Hospitals with higher rates often initiated palliative care earlier (correlation: 0.39; p<0.01).

Conclusion Despite an increase over time in the palliative care rate, its initiation was late and of brief duration. Palliative care use was associated with patient and hospital characteristics; however, half of the between hospital variation remained unexplained. The observed suboptimal practices and variability indicate the need for expanded and standardised use of palliative care supported by assessment tools, service enhancement and protocols.

  • palliative care
  • hospitalisation
  • end of life
  • inter-hospital variation

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  • Contributors HA, JMS and HMA were responsible for the conception, design, analysis, interpretation and writing. LTTT, SG and MA contributed to conception, interpretation and writing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethical approval was obtained from the NSW Population and Health Services Research Ethics Committee (HREC/16/CIPHS/37).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data statement Data cannot be made publicly available due to restrictions imposed by data custodians. Data are available upon request from the Secure Analytics for Population Health Research and Intelligence (SAPHaRI) system made available by the Centre for Epidemiology and Evidence ( and from the NSW Ministry of Health Centre For Health Record Linkage (