A national population administrative secondary care data linkage study
Pre-print publication: https://www.medrxiv.org/content/10.1101/2020.09.29.20203794v1
People who are nearing the end of life are high users of hospital services. The absolute cost to providers and its value is uncertain. There is a need to identify which groups of people spend a lot of time in hospital so that care can be modified to better tailor care to patients preferences and to improve the efficiency health services in this context.
Objectives: To describe the pattern, trajectory and drivers of secondary care use and cost by people in Scotland in their last year of life. Methods: Retrospective whole-population secondary care administrative data linkage study of Scottish decedents of 60 years and over between 2012 and 2017 (N=274,048).
Results: Secondary care use was high in the last year of life with a sharp rise in inpatient admissions in the last three months. The mean cost was 10,000 pound. Cause of death was associated with differing patterns of healthcare use: dying of cancer was preceded by the greatest number of hospital admissions and dementia the least. Greater age was associated with lower admission rates and cost. There was higher resource use in the urban areas. No difference was observed by deprivation.
- Hospitalisation near the end of life was least frequent for older people and those living rurally, although length of stay for both groups, when they were admitted, was longer.
- Research is required to understand if variation in hospitalisation is due to variation in the quantity or quality of end of life care available, varying community support, patient preferences or an inevitable consequence of disease-specific needs.