ArticleBMC medicine2022
Longitudinal patterns and predictors of healthcare utilization among cancer patients on home-based palliative care in Singapore: a group-based multi-trajectory analysis.
Article in BMC medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed.
- Leveraging Real-World Data for Clinical Decision Making in Geriatric Oncology.Drugs & aging · 2026Review
- The impact of municipal healthcare setting on the quality of end-of-life care: a population-based cohort study.BMC palliative care · 2026Article
- Placental Vascular Resistance and Offspring Growth From Birth to Age 2 Years.JAMA network open · 2025Article
- Identifying clusters of healthcare expenditure trajectories in end-stage organ disease: a retrospective cohort study using linked administrative databases in Singapore.BMC health services research · 2025Article
- Evaluating health-related quality of life and health resource utilization among Gabapentinoid users with substance use disorder in the US: Trends, co-prescriptions, and cost analysis.Exploratory research in clinical and social pharmacy · 2025Article
- Hospital care trajectories of older adults with cancer and the associated clinical profiles.The oncologist · 2025Article
- Analysis of longitudinal patterns and predictors of medicine use in residential aged care using group-based trajectory modelling: The MEDTRAC-Polypharmacy longitudinal cohort study.British journal of clinical pharmacology · 2024Article
- Associations of prenatal blood pressure trajectory and variability with child neurodevelopment at 2 years old.BMC medicine · 2024Article
- Towards proactive palliative care in oncology: developing an explainable EHR-based machine learning model for mortality risk prediction.BMC palliative care · 2024Article
- Article
- Characterizing hospitalization trajectories in the high-need, high-cost population using electronic health record data.Health affairs scholar · 2023Article
- A longitudinal area classification of migration in Great Britain: Testing the application of Group-Based Multi-Trajectory Modelling.Population, space and place · 2023Article
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9 authors.
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Abstract
backgroundHome-based palliative care (HPC) is considered to moderate the problem of rising healthcare utilization of cancer patients at end-of-life. Reports however suggest a proportion of HPC patients continue to experience high care intensity. Little is known about differential trajectories of healthcare utilization in patients on HPC. Thus, we aimed to uncover the heterogeneity of healthcare utilization trajectories in HPC patients and identify predictors of each utilization pattern.
methodsThis is a cohort study of adult cancer patients referred by Singapore Health Services to HCA Hospice Service who died between 1st January 2018 and 31st March 2020. We used patient-level data to capture predisposing, enabling, and need factors for healthcare utilization. Group-based multi-trajectory modelling was applied to identify trajectories for healthcare utilization based on the composite outcome of emergency department (ED) visits, hospitalization, and outpatient visits.
resultsA total of 1572 cancer patients received HPC (median age, 71 years; interquartile range, 62-80 years; 51.1% female). We found three distinct trajectory groups: group 1 (31.9% of cohort) with persistently low frequencies of healthcare utilization, group 2 (44.1%) with persistently high frequencies, and group 3 (24.0%) that begin with moderate frequencies, which dropped over the next 9 months before increasing in the last 3 months. Predisposing (age, advance care plan completion, and care preferences), enabling (no medical subsidy, primary decision maker), and need factors (cancer type, comorbidity burden and performance status) were significantly associated with group membership. High symptom needs increased ED visits and hospitalizations in all three groups (ED visits, group 1-3: incidence rate ratio [IRR] 1.74-6.85; hospitalizations, group 1-3: IRR 1.69-6.60). High home visit intensity reduced outpatient visits in all three groups (group 1-3 IRR 0.54-0.84), while it contributed to reduction of ED visits (IRR 0.40; 95% CI 0.25-0.62) and hospitalizations (IRR 0.37; 95% CI 0.24-0.58) in group 2.
conclusionsThis study on HPC patients highlights three healthcare utilization trajectories with implications for targeted interventions. Future efforts could include improving advance care plan completion, supporting care preferences in the community, proactive interventions among symptomatic high-risk patients, and stratification of home visit intensity.
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