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End-stage organ disease–Healthcare utilisation: Impact of palliative medicine
  1. Allyn Hum1,2,
  2. Chun Wei Yap3 and
  3. Mervyn Yong Hwang Koh1,2
  1. 1Palliative Medicine Department, Tan Tock Seng Hospital, Singapore
  2. 2The Palliative Care Centre for Excellence in Research and Education (PalC), Singapore
  3. 3National Healthcare Group Health Services and Outcomes Research, Singapore
  1. Correspondence to Dr Allyn Hum, Palliative Medicine, Tan Tock Seng Hospital, Singapore, 308433, Singapore; allyn_hum{at}


Objectives Although patients living with end-stage organ disease (ESOD) suffer unmet needs from the physical and emotional burdens of living with chronic illness, they are less likely to receive palliative care.

The aims of the study were to determine if palliative care referrals reduced healthcare utilisation and if impact on healthcare utilisation was dependent on the timing of the referral.

Methods Patients with ESOD who received palliative care support were matched with those who did not using coarsened exact matching and propensity score matching, and compared in this retrospective cohort study. Primary outcomes of interests were reduction in all-cause emergency department (ED) visits and costs, reduction in all-cause tertiary hospital admissions, length of hospital stay and inpatient hospital costs.

Results Patients with ESOD referred to palliative care experienced a reduction in the frequency of all cause ED visits and inpatient hospital admissions. Significant impact of a palliative care referral was at 3 months, rather than 1 month prior to death with a greater reduction in the frequency of ED visits, inpatient hospital admissions, length of stay and charges (p all <0.05). The most common ESOD referred to palliative care for 1110 matched patients was end-stage renal failure (57.7%), and least commonly for respiratory failure (7.6%).

Conclusion Palliative care can reduce healthcare utilisation, with reduction greatest when the referral is timed earlier in the disease trajectory. Cost savings can be judiciously redirected to the development of palliative care resources for integrated support of patients and caregivers.

  • renal failure
  • heart failure
  • respiratory conditions
  • chronic conditions

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. NA.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. NA.

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  • Contributors AH, CWY and MYHK were involved in the writing and organisation of the final manuscript, with the first author AH taking the lead. The study was conceptualised by AH, CWY and MYHK. The primary analysis of the data was conducted by the second author CWY.

  • 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.

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