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Incidence, duration and cost of futile treatment in end-of-life hospital admissions to three Australian public-sector tertiary hospitals: a retrospective multicentre cohort study.

ABSTRACT: OBJECTIVES:To estimate the incidence, duration and cost of futile treatment for end-of-life hospital admissions. DESIGN:Retrospective multicentre cohort study involving a clinical audit of hospital admissions. SETTING:Three Australian public-sector tertiary hospitals. PARTICIPANTS:Adult patients who died while admitted to one of the study hospitals over a 6-month period in 2012. MAIN OUTCOME MEASURES:Incidences of futile treatment among end-of-life admissions; length of stay in both ward and intensive care settings for the duration that patients received futile treatments; health system costs associated with futile treatments; monetary valuation of bed days associated with futile treatment. RESULTS:The incidence rate of futile treatment in end-of-life admissions was 12.1% across the three study hospitals (range 6.0%-19.6%). For admissions involving futile treatment, the mean length of stay following the onset of futile treatment was 15 days, with 5.25 of these days in the intensive care unit. The cost associated with futile bed days was estimated to be $AA12.4?million for the three study hospitals using health system costs, and $A988?000 when using a decision maker's willingness to pay for bed days. This was extrapolated to an annual national health system cost of $A153.1?million and a decision maker's willingness to pay of $A12.3?million. CONCLUSIONS:The incidence rate and cost of futile treatment in end-of-life admissions varied between hospitals. The overall impact was substantial in terms of both the bed days and cost incurred. An increased awareness of these economic costs may generate support for interventions designed to reduce futile treatments. We did not include emotional hardship or pain and suffering, which represent additional costs.

SUBMITTER: Carter HE

PROVIDER: S-EPMC5652539 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

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Incidence, duration and cost of futile treatment in end-of-life hospital admissions to three Australian public-sector tertiary hospitals: a retrospective multicentre cohort study.

Carter Hannah E HE Winch Sarah S Barnett Adrian G AG Parker Malcolm M Gallois Cindy C Willmott Lindy L White Ben P BP Patton Mary Anne MA Burridge Letitia L Salkield Gayle G Close Eliana E Callaway Leonie L Graves Nicholas N

BMJ open 20171016 10

<h4>Objectives</h4>To estimate the incidence, duration and cost of futile treatment for end-of-life hospital admissions.<h4>Design</h4>Retrospective multicentre cohort study involving a clinical audit of hospital admissions.<h4>Setting</h4>Three Australian public-sector tertiary hospitals.<h4>Participants</h4>Adult patients who died while admitted to one of the study hospitals over a 6-month period in 2012.<h4>Main outcome measures</h4>Incidences of futile treatment among end-of-life admissions; ...[more]

PMID: 29038186

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Project description:ObjectivesDespite the burden of venous thromboembolism (VTE) among surgical patients on health systems in Australia, data on VTE incidence and its variation within Australia are lacking. We aim to explore VTE and subsequent mortality rates, trends and variations across Australian acute public hospitals.SettingA large retrospective cohort study using all elective surgical patients in 82 acute public hospitals during 2002-2009 in New South Wales, Australia.ParticipantsPatients underwent elective surgery within 2 days of admission, aged between 18 and 90 years, and who were not transferred to another acute care facility; 4 362 624 patients were included.Outcome measuresVTE incidents were identified by secondary diagnostic codes. Poisson mixed models were used to derive adjusted incidence rates and rate ratios (IRR).Results2/1000 patients developed postoperative VTE. VTE increased by 30% (IRR=1.30, CI 1.19 to 1.42) over the study period. Differences in the VTE rates, trends between hospital peer groups and between hospitals with the highest and those with the lowest rates were significant (between-hospital variation). Smaller hospitals, accommodated in two peer groups, had the lowest overall VTE rates (IRR=0.56:0.33 to 0.95; IRR=0.37:0.23 to 0.61) and exhibited a greater increase (64% and 237% vs 19%) overtime and greater between-hospital variations compared to larger hospitals (IRR=8.64:6.23 to 11.98; IRR=8.92:5.49 to 14.49 vs IRR=3.70:3.32 to 4.12). Mortality among patients with postoperative VTE was 8% and remained stable overtime. No differences in post-VTE death rates and trends were seen between hospital groups; however, larger hospitals exhibited less between-hospital variations (IRR=1.78:1.30 to 2.44) compared to small hospitals (IRR>23). Hospitals performed differently in prevention versus treatment of postoperative VTE.ConclusionsVTE incidence is increasing and there is large variation between-hospital and within-hospital peer groups suggesting a varied compliance with VTE preventative strategies and the potential for targeted interventions and quality improvement opportunities.

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Incidence, duration and cost of futile treatment in end-of-life hospital admissions to three Australian public-sector tertiary hospitals: a retrospective multicentre cohort study.

Publications

Incidence, duration and cost of futile treatment in end-of-life hospital admissions to three Australian public-sector tertiary hospitals: a retrospective multicentre cohort study.

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