Evidence map›Paper›PMID 33781119›Full record

ArticlePalliative medicine2021

Association between high cost user status and end-of-life care in hospitalized patients: A national cohort study of patients who die in hospital.

Kieran L Quinn, Amy T Hsu, Christopher Meaney, Danial Qureshi, Peter Tanuseputro, Hsien Seow, Colleen Webber, Rob Fowler, James Downar, Russell Goldman and 3 more

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Palliative medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
1.4field-weighted citation impact, top 19% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 13 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 5 institutions in 1 country.

Kieran L QuinnDepartment of Medicine, University of Toronto, Toronto, ON, Canada.ORCID https://orcid.org/0000-0002-1681-5170
Amy T HsuICES, Toronto and Ottawa, ON, Canada.
Christopher MeaneyDepartment of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
Danial QureshiICES, Toronto and Ottawa, ON, Canada.
Peter TanuseputroICES, Toronto and Ottawa, ON, Canada.ORCID https://orcid.org/0000-0002-4409-0795
Hsien SeowDepartment of Oncology, McMaster University, Hamilton, ON, Canada.ORCID https://orcid.org/0000-0001-6701-1714
Colleen WebberICES, Toronto and Ottawa, ON, Canada.ORCID https://orcid.org/0000-0001-9193-5386
Rob FowlerTory Trauma Program, Sunnybrook Hospital, Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Toronto, Ontario.
James DownarBruyère Research Institute, Ottawa, ON, Canada.
Russell GoldmanDepartment of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
Raphael ChanDivision of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Kimberlyn McGrailCentre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada.
Sarina R IsenbergInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.ORCID https://orcid.org/0000-0001-6059-5366
University of Ottawa · CAUniversity of Toronto · CAMcMaster University · CAOttawa Hospital · CAUniversity of British Columbia · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundStudies comparing end-of-life care between patients who are high cost users of the healthcare system compared to those who are not are lacking.

aimThe objective of this study was to describe and measure the association between high cost user status and several health services outcomes for all adults in Canada who died in acute care, compared to non-high cost users and those without prior healthcare use. SETTINGS AND

participantsWe used administrative data for all adults who died in hospital in Canada between 2011 and 2015 to measure the odds of admission to the intensive care unit (ICU), receipt of invasive interventions, major surgery, and receipt of palliative care during the hospitalization in which the patient died. High cost users were defined as those in the top 10% of acute healthcare costs in the year prior to a person's hospitalization in which they died.

resultsAmong 252,648 people who died in hospital, 25,264 were high cost users (10%), 112,506 were non-high cost users (44.5%) and 114,878 had no prior acute care use (45.5%). After adjustment for age and sex, high cost user status was associated with a 14% increased odds of receiving an invasive intervention, a 15% increased odds of having major surgery, and an 8% lower odds of receiving palliative care compared to non-high cost users, but opposite when compared to patients without prior healthcare use.

conclusionsMany patients receive aggressive elements of end-of-life care during the hospitalization in which they die and a substantial number do not receive palliative care. Understanding how this care differs between those who were previously high- and non-high cost users may provide an opportunity to improve end of life care for whom better care planning and provision ought to be an equal priority.

Indexed as

Terminal CareAdultCohort StudiesHospitalizationHospitalsHumansPalliative CareRetrospective Studiesdelivery of healthcareend-of-lifeHigh cost userspalliative care

Identifiers

PMID33781119
PMCPMC8532234
OpenAlexW3146762401

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.