Potentially Inappropriate End of Life Care and Healthcare Costs in the Last 30 Days of Life in Regions Providing Integrated Palliative Care in the Netherlands: A Registration-based Study

Chantal F R Pereira; Anne-Floor Q Dijxhoorn; Berdine Koekoek; Monique van den Broek; Karin van der Steen; Marijanne Engel; Marjon van Rijn; Judith M Meijers; Jeroen Hasselaar; Agnes van der Heide; Bregje D Onwuteaka-Philipsen; Marieke H J van den Beuken-van Everdingen; Yvette M van der Linden; Manon S Boddaert; Patrick P T Jeurissen; Matthias A W Merkx; Natasja J H Raijmakers

doi:10.5334/ijic.7504

Potentially Inappropriate End of Life Care and Healthcare Costs in the Last 30 Days of Life in Regions Providing Integrated Palliative Care in the Netherlands: A Registration-based Study

Int J Integr Care. 2024 Jul 8;24(3):6. doi: 10.5334/ijic.7504. eCollection 2024 Jul-Sep.

Authors

Chantal F R Pereira^#¹, Anne-Floor Q Dijxhoorn^#^{1

2

3}, Berdine Koekoek⁴, Monique van den Broek⁵, Karin van der Steen⁶, Marijanne Engel⁷, Marjon van Rijn^{8

9}, Judith M Meijers^{10

11}, Jeroen Hasselaar¹², Agnes van der Heide¹³, Bregje D Onwuteaka-Philipsen¹⁴, Marieke H J van den Beuken-van Everdingen¹⁵, Yvette M van der Linden³, Manon S Boddaert^{1

2

3}, Patrick P T Jeurissen¹⁶, Matthias A W Merkx^{1

16}, Natasja J H Raijmakers^{1

2}

Affiliations

¹ Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
² Netherlands Association for Palliative Care, Utrecht, The Netherlands.
³ Center of Expertise in Palliative Care, Leiden University Medical Center, Leiden, The Netherlands.
⁴ Gelre Hospitals, Apeldoorn, Netherlands Apeldoorn, The Netherlands.
⁵ Synchroon, Oss, The Netherlands.
⁶ Proscoop, Zwolle, The Netherlands.
⁷ Center of Expertise in Palliative Care Utrecht, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
⁸ Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam UMC -Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
⁹ Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Science, Amsterdam, the Netherlands.
¹⁰ Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
¹¹ Zuyderland Care, Zuyderland Medical Center, Sittard-Geleen, The Netherlands.
¹² Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
¹³ Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
¹⁴ Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC -. Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
¹⁵ Center of Expertise in Palliative Care, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.
¹⁶ Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Nijmegen, The Netherlands.

^# Contributed equally.

Abstract

Introduction: This study aimed to assess the effect of integrated palliative care (IPC) on potentially inappropriate end- of-life care and healthcare-costs in the last 30 days of life in the Netherlands.

Methods: Nationwide health-insurance claims data were used to assess potentially inappropriate end-of-life care (≥2 emergency room visits; ≥2 hospital admissions; >14 days hospitalization; chemotherapy; ICU admission; hospital death) and healthcare-costs in all deceased adults in IPC regions pre- and post- implementation and in those receiving IPC compared to a 1:2 matched control group.

Results: In regions providing IPC deceased adults (n = 37,468) received significantly less potentially inappropriate end-of-life care post-implementation compared to pre-implementation (26.5% vs 27.9%; p < 0.05). Deceased adults who received IPC (n = 210) also received significantly less potentially inappropriate end-of-life care compared to a matched control group (14.8% vs 28.3%; p < 0.05). Mean hospital costs significantly decreased for deceased adults who received IPC (€2,817), while mean costs increased for general practitioner services (€311) and home care (€1,632).

Discussion: These results highlight the importance of implementation of integrated palliative care and suitable payment. Further research in a larger sample is needed.

Conclusion: This study shows less potentially inappropriate end-of-life care and a shift in healthcare costs from hospital to general practitioner and home care with IPC.

Keywords: Deceased adults; Health economics; Medicine; Nursing; healthcare costs; integrated palliative care; palliative care; potentially inappropriate end of life care.