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Transition between care settings at end of life in the Netherlands: results from a nationwide study.
Abarshi, E., Echteld, M., Block, L. van den, Donker, G., Deliens, L., Onwuteaka-Philipsen, B. Transition between care settings at end of life in the Netherlands: results from a nationwide study. SMW: Schweizerische Medizinische Wochenschrift: 2009, 139(Suppl. 175), p. S 43. 15th Wonca Europe Conference, 16-19 september 2009, Basel (Switzerland).
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Background: Transitions between care settings at the end of life could hinder continuity of care for the terminally ill, suggesting a low quality of end-of-life care. Objective: To examine the nature and prevalence of care setting transitions in the last 3 months of life in the Netherlands, and to identify potential characteristics associated with them. Methods: Between January 2005 and December 2006, we performed a mortality follow-back study on all non-sudden deaths for patients aged >= 1 year. Data were collected via the Dutch Sentinel Network General Practitioners (GPs), an existing health surveillance network representative of all GPs in the Netherlands. A care setting transition was defined as a change in setting of care.Results. During the 2-year period we studied 690 patients whose deaths were “expected and non-sudden”. In the last 3 months of life, 43 distinct care trajectories and 709 transitions were identified (involving a hospital 2 / 3 of times). The most frequent trajectory was home-hospital (48%). Forty-six percent experienced >= 1 transition in their last month of life. Being male, multi-morbidity, and absent GP-awareness of a patient’s preferred place of death were associated with having a transition in the last 30 days; whereas being <= 85 years, having an infection and absent palliative-centred treatment goal were associated with terminal hospitalisation for >= 7 days. Conclusion: Although majority of non-sudden deaths occur at home, transitions to hospitals are relatively frequent. To minimize unnecessary or unwanted transitions, timely recognition of the palliative phase of dying is important. (aut. ref.)
Background: Transitions between care settings at the end of life could hinder continuity of care for the terminally ill, suggesting a low quality of end-of-life care. Objective: To examine the nature and prevalence of care setting transitions in the last 3 months of life in the Netherlands, and to identify potential characteristics associated with them. Methods: Between January 2005 and December 2006, we performed a mortality follow-back study on all non-sudden deaths for patients aged >= 1 year. Data were collected via the Dutch Sentinel Network General Practitioners (GPs), an existing health surveillance network representative of all GPs in the Netherlands. A care setting transition was defined as a change in setting of care.Results. During the 2-year period we studied 690 patients whose deaths were “expected and non-sudden”. In the last 3 months of life, 43 distinct care trajectories and 709 transitions were identified (involving a hospital 2 / 3 of times). The most frequent trajectory was home-hospital (48%). Forty-six percent experienced >= 1 transition in their last month of life. Being male, multi-morbidity, and absent GP-awareness of a patient’s preferred place of death were associated with having a transition in the last 30 days; whereas being <= 85 years, having an infection and absent palliative-centred treatment goal were associated with terminal hospitalisation for >= 7 days. Conclusion: Although majority of non-sudden deaths occur at home, transitions to hospitals are relatively frequent. To minimize unnecessary or unwanted transitions, timely recognition of the palliative phase of dying is important. (aut. ref.)
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