br Acknowledgments br Introduction Since
Introduction Since the first hospice was established in the United Kingdom in the late 1960s, the use of hospice and palliative care has become popular worldwide. In developed countries, hospice and palliative care are now used for services ranging from in-patient to community/home care. The place of death is an important issue for terminally ill patients, and evidence-based research has shown that dying at home is considered to improve the general quality of care. Hospice care was introduced in Taiwan in the late 1980s, and has been covered by the National Health Insurance (NHI) program since 2000. In Taiwan, the model of palliative care differs from that used in Western countries. None of the hospices in Taiwan are independent institutions, but are rather affiliated with general hospitals, similar to palliative care units of hospitals in the West. At present, there are around 53 hospices with 718 in-patient beds in Taiwan. Cancer patients account for the majority of terminal patients under hospice care, even though the NHI has provided in-patient reimbursements for noncancer hospice care since 2009. The place of death is recorded for all terminal patients admitted to hospices. However, detailed information on the place of death for terminal cancer patients has not previously been reported. Choosing impending death discharge (IDD) is a unique predying behavior for terminal patients in Taiwan. According to traditional culture, out-of-home death is thought to bring bad luck for the deceased in the afterlife, whereas dying at home and being cared for by younger family members is thought to bring good fortune. An epidemiological study in Taiwan that reviewed death certificates found that approximately 97% of out-of-hospital cancer-related deaths occurred at the patient\'s home. Thus, an IDD code in the National Health Insurance Research Database (NHIRD) can be considered to indicate dying at home. Therefore, the aim of this CCK Octapeptide, non-sulfated manufacturer study was to investigate differences between terminal cancer patients with IDD and those who died in hospices.
Methods This retrospective study collected data on patients who died from cancer whose NHI claims records were marked with hospice care from the NHIRD in Taiwan from 2007 to 2010. The NHIRD is maintained by the National Health Research Institute of Taiwan, and provides anonymized and encrypted data for research purposes. In this study, we screened in-patient claims data in the NHIRD from 2007 to 2010. The terminal admission claims data marked with “4” (expired, died in a hospice) and “A” (IDD) were collected. Claims data before 2007 were not analyzed because of incomplete information (Fig. 1).
Results From 2007 to 2010, 22,720 patients who died from cancer and received hospice care were enrolled, including 6316 with IDD and 16,404 who died in a hospice. The numbers in both groups increased annually over the study period, with the relative percentage of patients with IDD increasing more markedly than those dying in hospices (from 23.4% to 30.1%). The trend of the percentage for patients\' place of death is shown in Fig. 2. The general information of the patients and the types of cancer are shown in Table 1. Most of the patients in both groups were aged between 60 years and 79 years. Patients with IDD had an older mean age than those who died in a hospice, and also a significantly shorter mean hospice stay and lower rate of hospice stay over 14 days. The patients with IDD also had higher rates of gastrointestinal or peritoneal cancer and pulmonary cancer. By contrast, those who died in a hospice had higher rates of oropharyngeal cancer, bone/connective tissue/breast cancers, other primary cancers, and secondary/metastatic cancers. The hospital sections involved in the terminal admissions and the in-patient costs are listed in Table 2. Most of the patients in both groups (>70%) were treated at family medicine and oncology/hematology departments for their terminal hospice admission. Among the patients with IDD, more were treated at family medicine and oncology/hematology departments than were those dying in hospices, who were most frequently treated at internal medicine and radiation oncology departments. The mean daily terminal hospice admission cost was higher in those with IDD, but the total cost of the terminal hospice admission was higher in those who died in a hospice.