ArticleBMJ supportive & palliative care2019
Factors associated with variation in hospital use at the end of life in England.
Article in BMJ supportive & palliative care, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 36 citations in OpenAlex.
- An optimisation framework for resource allocation in palliative and end-of-life care.Scientific reports · 2026Article
- Ethnic disparities in opioid prescribing for cancer pain and associated emergency department visits and hospital admissions in the last three months of life: a retrospective cohort study.British journal of cancer · 2025Article
- Geographic variations in end-of-life hospitalisations for patients with mental illness: a population-based observational study in England, UK.Discover mental health · 2025Article
- Patterns of acute hospital and specialist palliative care use among people with non-curative upper gastrointestinal cancer.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2024Article
- "Before I came to the hospice, I had nobody". A qualitative exploration of what patients, family-caregivers, clinicians and volunteers valued most about home, day therapy or inpatient hospice services.Palliative care and social practice · 2024Article
- Patient emergency health-care use before hospital admission for COVID-19 and long-term outcomes in Scotland: a national cohort study.The Lancet. Digital health · 2023Article
- Unwarranted variations in end-of-life care and the impact of using an electronic coordination system.Research in health services & regions · 2023Article
- Socioeconomic position and use of hospital-based care towards the end of life: a mediation analysis using the English Longitudinal Study of Ageing.The Lancet. Public health · 2021Observational
- A scoping review of initiatives to reduce inappropriate or non-beneficial hospital admissions and bed days in people nearing the end of their life: much innovation, but limited supporting evidence.BMC palliative care · 2020Article
- Article
- Ambulance staff and end-of-life hospital admissions: A qualitative interview study.Palliative medicine · 2018Article
Corrections and comments
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Authors and funding
4 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo identify the relative importance of factors influencing hospital use at the end of life.
designRetrospective cohort study of person and health system effects on hospital use in the past 12 months modelling differences in admissions, bed days and whether a person died in hospital.
settingResidents in England for the period 2009/2010 to 2011/2012 using Hospital Episodes Statistics (HES) data from all acute care hospitals in England funded by the National Health Service (NHS).
participants1 223 859 people registered with a GP in England who died (decedents) in England (April 2009-March 2012) with a record of NHS hospital care.
main outcome measuresHospital admissions, and hospital bed days and place of death (in or out of hospital) in the past 12 months of life.
resultsThe mean number of admissions in the past 12 months of life averaged 2.28 occupying 30.05 bed days-excluding 9.8% of patients with no hospital history. A total of 50.8% of people died in hospital. Difference in hospital use was associated with a range of patient descriptors (age, gender and ethnicity). The variables with the greatest 'explanatory power' were those that described the diagnoses and causes of death. So, for example, 65% of the variability in the model of hospital admissions was explained by diagnoses. Only moderate levels of variation were explained by the hospital provider variables for admissions and deaths in hospital, though the impacts on total bed days was large.
conclusionsComparative analyses of hospital utilisation should standardise for a range of patient specific variables. Though the models indicated some degree of variability associated with individual providers, the scale of this was not great for admissions and death in hospital but the variability associated with length of stay differences suggests that attempts to optimise hospital use should look at differences in lengths of stay and bed use. This study adds important new information about variability in admissions by diagnostic group, and variability in bed days by diagnostic group and eventual cause of death.
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