RT Journal Article
SR Electronic
T1 End-of-life care in cancer and dementia: a nationwide population-based study of palliative care policy changes
JF BMJ Supportive & Palliative Care
JO BMJ Support Palliat Care
FD British Medical Journal Publishing Group
SP e384
OP e392
DO 10.1136/bmjspcare-2019-001782
VO 12
IS e3
A1 Lou-Ching Kuo
A1 Jung Jae Lee
A1 Denise Shuk Ting Cheung
A1 Ping-Jen Chen
A1 Chia-Chin Lin
YR 2022
UL http://spcare.bmj.com/content/12/e3/e384.abstract
AB Objectives The National Health Insurance programme started providing coverage for inpatient care in palliative care (PC) units of acute care hospitals in 2000; however, initially, only PC provided to patients with terminal cancer was covered. A PC policy that enabled PC reimbursement for patients with dementia was implemented in 2009. However, the association of this PC policy with end-of-life care remains unclear. The study aims to compare the association of the PC policy with end-of-life care between patients with dementia and patients with cancer during the last 6 months of their lives.Methods We analysed the claims data of 7396 patients dying with dementia (PDD) and 24 319 patients dying with cancer (PDC) during 1997–2013.Results Among PDC, while the percentage of receiving PC increased from 3.6% in 1999 to 14.2% by the end of 2000 (adjusted OR (aOR)=4.07, 95% CI 2.70 to 6.13) and from 20.9% in 2010 to 41.0% in 2013 (aOR=1.40, 95% CI 1.33 to 1.47), vasopressor use decreased from 71.6% in 1999 to 35.5% in 2001 (aOR=0.90, 95% CI 0.82 to 0.98). Among PDD, PC use increased from 0.2% in 2009 to 4.9% in 2013 (aOR=2.05, 95% CI 1.60 to 2.63) and cardiopulmonary resuscitation use decreased from 17.6% in 2009 to 10.0% in 2013 (aOR=0.83, 95% CI 0.76 to 0.90).Conclusions Implementation of the PC policy in Taiwan was associated with improved PC utilisation among patients with cancer and dementia, which may reduce unnecessary medical care procedures.This study was based on data from the Taiwan National Health Insurance Research Database, which was provided by the National Health Insurance Administration, Ministry of Health and Welfare, and is managed by the National Health Research Institutes.