PT  - JOURNAL ARTICLE
AU  - Allyn Hum
AU  - Chun Wei Yap
AU  - Mervyn Yong Hwang Koh
TI  - End-stage organ disease–Healthcare utilisation: Impact of palliative medicine
AID  - 10.1136/bmjspcare-2021-003288
DP  - 2021 Oct 16
TA  - BMJ Supportive & Palliative Care
PG  - bmjspcare-2021-003288
4099  - http://spcare.bmj.com/content/early/2021/10/17/bmjspcare-2021-003288.short
4100  - http://spcare.bmj.com/content/early/2021/10/17/bmjspcare-2021-003288.full
AB  - 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.All data relevant to the study are included in the article or uploaded as online supplemental information. NA.