Resource use, costs and quality of end-of-life care: observations in a cohort of elderly Australian cancer decedents
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Resource use, costs and quality of end-of-life care: observations in a cohort of elderly Australian cancer decedents Julia M Langton1, Preeyaporn Srasuebkul1, Rebecca Reeve2, Bonny Parkinson2, Yuanyuan Gu2, Nicholas A Buckley3, Marion Haas2, Rosalie Viney2, Sallie-Anne Pearson1,3*, The End-of-Life in Cancer Care (EoL-CC) Investigators
Abstract Background: The last year of life is one of the most resource-intensive periods for people with cancer. Very little population-based research has been conducted on end-of-life cancer care in the Australian health care setting. The objective of this program is to undertake a series of observational studies examining resource use, costs and quality of end-of-life care in a cohort of elderly cancer decedents using linked, routinely collected data. Methods/Design: This study forms part of an ongoing cancer health services research program. The cohorts for the end-of-life research program comprise Australian Government Department of Veterans’ Affairs decedents with full health care entitlements, residing in NSW for the last 18 months of life and dying between 2005 and 2009. We used cancer and death registry data to identify our decedent cohorts and their causes of death. The study population includes 9,862 decedents with a cancer history and 15,483 decedents without a cancer history. The median age at death is 86 and 87 years in the cancer and non-cancer cohorts, respectively. We will examine resource use and associated costs in the last 6 months of life using linked claims data to report on health service use, hospitalizations, emergency department visits and medicines use. We will use best practice methods to examine the nature and extent of resource use, costs and quality of care based on previously published indicators. We will also examine factors associated with these outcomes. Discussion: This will be the first Australian research program and among the first internationally to combine routinely collected data from primary care and hospital-based care to examine comprehensively end-of-life care in the elderly. The research program has high translational value, as there is limited evidence about the nature and quality of care in the Australian end-of-life setting. Keywords: End-of-life, Cancer, Palliative care, Resource utilization, Costs, Patterns of care
Background Cancer care imposes a significant burden on health systems globally with the year following diagnosis and last year of life being the most resource-intensive stages of care [1]. Relative to the evidence-base supporting clinical decisionmaking at the time of a cancer diagnosis, there is limited understanding about what constitutes quality end-of-life care [2-5]. Randomized trials of end-of-life treatments and services remain rare and likely to remain so for ethical and * Correspondence: [email protected] 1 Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia 3 Sydney Medical School, The University of Sydney, Sydney, NSW, Australia Full list of author infor
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