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Abstract
Objectives Palliative patients generally prefer to be cared for and die at home. Overly aggressive treatments place additional strain on already burdened patients and healthcare services, contributing to decreased quality of life and increased healthcare costs. This study characterises palliative inpatients, quantifies in-hospital mortality and potentially avoidable hospitalisations.
Methods We conducted a multicentre retrospective analysis using the national inpatient cohort. The extracted data encompassed all inpatients for palliative care spanning the years 2012–2021. The dataset comprised information on demographics, diagnoses, comorbidities, treatments and clinical outcomes. Content experts reviewed a list of treatments for which no hospitalisation was required.
Results 120 396 hospitalisation records indicated palliative patients. Almost half were women (n=59 297, 49%). Most patients were ≥65 years old. 66% had an oncologic primary diagnosis. The majority were admitted from home (82 443; 69%). The patients stayed a median of 12 days (6–20). All treatments for 25 188 patients (21%) could have been performed at home. In-hospital deaths ended 64 739 stays (54%); of note, 10% (n=6357/64 739) of in-hospital deaths occurred within 24 hours.
Conclusions In this nationwide study of palliative inpatients, two-thirds were 65 years old and older. Regarding the performed treatments alone, a fifth of these hospitalisations can be considered as avoidable. More than half of the patients died during their hospital stay, and 1 in 10 of those within 24 hours.
- end of life care
- home care
- hospice care
- hospital care
- supportive care
- terminal care
Data availability statement
Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. All data relevant to the study are included in the article or uploaded as supplementary information. The national inpatient cohort by the federal statistical office with anonymous data originates from a third party and is not publicly available. The used codes for the analysis and statistics are available upon reasonable request. The used definition of codes for the detection of potentially avoidable admissions is included in the supplementary information.
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Data availability statement
Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. All data relevant to the study are included in the article or uploaded as supplementary information. The national inpatient cohort by the federal statistical office with anonymous data originates from a third party and is not publicly available. The used codes for the analysis and statistics are available upon reasonable request. The used definition of codes for the detection of potentially avoidable admissions is included in the supplementary information.
Footnotes
Contributors PEB conceived and designed the study. BH processed the data and performed the statistical analyses, with contributions by PEB. All authors interpreted data. BH drafted the work with PEB, BM and BLH critically commenting on it. PEB acts as guarantor. All authors approved the final submitted version of the manuscript.
Funding This study was supported by the Center for Primary and Community Care, University of Lucerne, Lucerne, Switzerland. The funding source played no role in the design and conduct of this study; the collection, management, analysis of the data or the interpretation of the results; the review and approval of the manuscript.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
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