Open AccessNational Policies Fostering Hospice Care Increased Hospice Utilization and Reduced the Invasiveness of End‐of‐Life Care for Cancer Patients
Author(s) -
Shao YuYun,
Hsiue Emily HanChung,
Hsu ChihHung,
Yao ChienAn,
Chen HoMin,
Lai MeiShu,
Cheng AnnLii
Publication year - 2017
Publication title -
the oncologist
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.176
H-Index - 164
eISSN - 1549-490X
pISSN - 1083-7159
DOI - 10.1634/theoncologist.2016-0367
Subject(s) - hospice care , medicine , end of life care , cancer , intensive care medicine , nursing , gerontology , palliative care , family medicine
Background In 2011, two national policies aiming to foster hospice services for terminal cancer patients took effect in Taiwan. The single‐payer National Health Insurance of Taiwan started to reimburse full hospice services. The national hospital accreditation program, which graded all hospitals, incorporated hospice utilization in its evaluation. We assessed the impact of these national policies. Methods A cohort of 249,394 patients aged ≥18 years who died of cancer between 2008 and 2013 were identified from the National Death Registry. We retrieved utilization data of medical services and compared the health care utilization in the final month of life before and after the implementation of the new policies. Results After the policy changes, hospice utilization increased from 20.8% to 36.2%. In a multivariate analysis adjusting for patient demographics, cancer features, and hospital characteristics, hospice utilization significantly increased after 2011 (adjusted odds ratio [AOR] 2.35, p < .001), accompanied by a decrease in intensive care unit (ICU) admissions, invasive mechanical ventilation (IMV), and cardiopulmonary resuscitation (CPR; AORs 0.87, 0.75, and 0.80, respectively; all p < .001). The patients who received hospice services were significantly less likely to receive ICU admissions, IMV, and CPR (AORs 0.20, 0.12, and 0.10, respectively; all p < .001). Hospice utilization was associated with an adjusted net savings of U.S. $696.90 (25.2%, p < .001) per patient in the final month of life. Conclusion The national policy changes fostering hospice care significantly increased hospice utilization, decreased invasive end‐of‐life care, and reduced the medical costs of terminal cancer patients. Implications for Practice National policies fostering hospice care significantly increased hospice utilization, decreased invasive end‐of‐life care, and reduced the medical costs of terminal cancer patients.