Diernberger Katharina, Luta Xhyljeta, Bowden Joanna, Fallon Marie, Droney Joanne, Lemmon Elizabeth, Gray Ewan, Marti Joachim, Hall Peter
Edinburgh Health Economics Group, University of Edinburgh, Edinburgh, UK.
Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK.
BMJ Support Palliat Care. 2021 Feb 12. doi: 10.1136/bmjspcare-2020-002708.
People who are nearing the end of life are high users of healthcare. The cost to providers is high and the value of care is uncertain.
To describe the pattern, trajectory and drivers of secondary care use and cost by people in Scotland in their last year of life.
Retrospective whole-population secondary care administrative data linkage study of Scottish decedents of 60 years and over between 2012 and 2017 (N=274 048).
Secondary care use was high in the last year of life with a sharp rise in inpatient admissions in the last 3 months. The mean cost was £10 000. 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.
接近生命末期的人群是医疗保健的高使用者。对医疗服务提供者来说成本高昂，而护理的价值却不确定。
描述苏格兰人在生命最后一年二级医疗服务的使用模式、轨迹及驱动因素和成本。
对2012年至2017年间60岁及以上的苏格兰逝者进行回顾性全人群二级医疗行政数据链接研究（N = 274048）。
在生命的最后一年，二级医疗服务的使用频率很高，在最后3个月住院人数急剧上升。平均费用为10000英镑。死因与不同的医疗保健使用模式相关：死于癌症之前的住院次数最多，而死于痴呆症的最少。年龄越大，住院率和费用越低。城市地区的资源使用更高。未观察到贫困程度之间的差异。
生命末期的住院治疗在老年人和农村居民中最不常见，尽管这两组人住院时的住院时间都更长。需要开展研究以了解住院治疗的差异是由于临终护理的数量或质量差异、社区支持不同、患者偏好还是疾病特定需求的必然结果。
