Unscheduled and out-of-hours care for people in their last year of life: a retrospective cohort analysis of national datasets
Objectives To analyse patterns of use and costs of unscheduled National Health Service (NHS) services for people in the last year of life.Design Retrospective cohort analysis of national datasets with application of standard UK costings.Participants and setting All people who died in Scotland in 201...
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BMJ Publishing Group
2020-11-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/11/e041888.full |
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| author | Kirsty Boyd Scott A Murray Sebastien Moine Andrew Stoddart Bruce Mason Joannes Joseph Kerssens Anne M Finucane |
| author_facet | Kirsty Boyd Scott A Murray Sebastien Moine Andrew Stoddart Bruce Mason Joannes Joseph Kerssens Anne M Finucane |
| author_sort | Kirsty Boyd |
| collection | DOAJ |
| description | Objectives To analyse patterns of use and costs of unscheduled National Health Service (NHS) services for people in the last year of life.Design Retrospective cohort analysis of national datasets with application of standard UK costings.Participants and setting All people who died in Scotland in 2016 aged 18 or older (N=56 407).Main outcome measures Frequency of use of the five unscheduled NHS services in the last 12 months of life by underlying cause of death, patient demographics, Continuous Unscheduled Pathways (CUPs) followed by patients during each care episode, total NHS and per-patient costs.Results 53 509 patients (94.9%) had at least one contact with an unscheduled care service during their last year of life (472 360 contacts), with 34.2% in the last month of life. By linking patient contacts during each episode of care, we identified 206 841 CUPs, with 133 980 (64.8%) starting out-of-hours. People with cancer were more likely to contact the NHS telephone advice line (63%) (χ2 (4)=1004, p<0.001) or primary care out-of-hours (62%) (χ2 (4)=1924,p<0.001) and have hospital admissions (88%) (χ2 (4)=2644, p<0.001). People with organ failure (79%) contacted the ambulance service most frequently (χ2 (4)=584, p<0.001). Demographic factors associated with more unscheduled care were older age, social deprivation, living in own home and dying of cancer. People dying with organ failure formed the largest group in the cohort and had the highest NHS costs as a group. The cost of providing services in the community was estimated at 3.9% of total unscheduled care costs despite handling most out-of-hours calls.Conclusions Over 90% of people used NHS unscheduled care in their last year of life. Different underlying causes of death and demographic factors impacted on initial access and subsequent pathways of care. Managing more unscheduled care episodes in the community has the potential to reduce hospital admissions and overall costs. |
| format | Article |
| id | doaj-art-3bf377970d9a43228ab29f4de53d49ea |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-3bf377970d9a43228ab29f4de53d49ea2025-08-20T02:27:46ZengBMJ Publishing GroupBMJ Open2044-60552020-11-01101110.1136/bmjopen-2020-041888Unscheduled and out-of-hours care for people in their last year of life: a retrospective cohort analysis of national datasetsKirsty Boyd0Scott A Murray1Sebastien Moine2Andrew Stoddart3Bruce Mason4Joannes Joseph Kerssens5Anne M Finucane6Primary Palliative Care Research Group, Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UKemeritus professor of primary palliative care4 Health Education and Practices Laboratory, University of Paris 13, Bobigny, FranceEdinburgh Health Services Research Unit, The University Of Edinburgh, Edinburgh, UKUniversity of Edinburgh, Marie Curie Hospice-Glasgow, Scottish Partnership for Palliative Care, NHS Highland, Marie Curie Hospice-Edinburgh2 Electronic Data Research and Innovation Service, Public Health Scotland, Edinburgh, UK1Marie Curie Hospice Edinburgh, 45 Frogston Road West, Edinburgh EH110 7DR, UKObjectives To analyse patterns of use and costs of unscheduled National Health Service (NHS) services for people in the last year of life.Design Retrospective cohort analysis of national datasets with application of standard UK costings.Participants and setting All people who died in Scotland in 2016 aged 18 or older (N=56 407).Main outcome measures Frequency of use of the five unscheduled NHS services in the last 12 months of life by underlying cause of death, patient demographics, Continuous Unscheduled Pathways (CUPs) followed by patients during each care episode, total NHS and per-patient costs.Results 53 509 patients (94.9%) had at least one contact with an unscheduled care service during their last year of life (472 360 contacts), with 34.2% in the last month of life. By linking patient contacts during each episode of care, we identified 206 841 CUPs, with 133 980 (64.8%) starting out-of-hours. People with cancer were more likely to contact the NHS telephone advice line (63%) (χ2 (4)=1004, p<0.001) or primary care out-of-hours (62%) (χ2 (4)=1924,p<0.001) and have hospital admissions (88%) (χ2 (4)=2644, p<0.001). People with organ failure (79%) contacted the ambulance service most frequently (χ2 (4)=584, p<0.001). Demographic factors associated with more unscheduled care were older age, social deprivation, living in own home and dying of cancer. People dying with organ failure formed the largest group in the cohort and had the highest NHS costs as a group. The cost of providing services in the community was estimated at 3.9% of total unscheduled care costs despite handling most out-of-hours calls.Conclusions Over 90% of people used NHS unscheduled care in their last year of life. Different underlying causes of death and demographic factors impacted on initial access and subsequent pathways of care. Managing more unscheduled care episodes in the community has the potential to reduce hospital admissions and overall costs.https://bmjopen.bmj.com/content/10/11/e041888.full |
| spellingShingle | Kirsty Boyd Scott A Murray Sebastien Moine Andrew Stoddart Bruce Mason Joannes Joseph Kerssens Anne M Finucane Unscheduled and out-of-hours care for people in their last year of life: a retrospective cohort analysis of national datasets BMJ Open |
| title | Unscheduled and out-of-hours care for people in their last year of life: a retrospective cohort analysis of national datasets |
| title_full | Unscheduled and out-of-hours care for people in their last year of life: a retrospective cohort analysis of national datasets |
| title_fullStr | Unscheduled and out-of-hours care for people in their last year of life: a retrospective cohort analysis of national datasets |
| title_full_unstemmed | Unscheduled and out-of-hours care for people in their last year of life: a retrospective cohort analysis of national datasets |
| title_short | Unscheduled and out-of-hours care for people in their last year of life: a retrospective cohort analysis of national datasets |
| title_sort | unscheduled and out of hours care for people in their last year of life a retrospective cohort analysis of national datasets |
| url | https://bmjopen.bmj.com/content/10/11/e041888.full |
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