Jocelyn Zwicker1, Danial Qureshi2, Robert Talarico2, Pierre Bourque2, Mary Scott2, Nicolas Chin-Yee2, Peter Tanuseputro2. 1. From the Department of Medicine (J.Z., D.Q., P.B., M.S., N.C.-Y., P.T.), Ottawa Hospital Research Institute, University of Ottawa; Bruyére Research Institute (D.Q., M.S., P.T.); and ICES-Population Health and Primary Care (R.T., P.T.), Ottawa, Canada. jzwicker@toh.ca. 2. From the Department of Medicine (J.Z., D.Q., P.B., M.S., N.C.-Y., P.T.), Ottawa Hospital Research Institute, University of Ottawa; Bruyére Research Institute (D.Q., M.S., P.T.); and ICES-Population Health and Primary Care (R.T., P.T.), Ottawa, Canada.
Abstract
OBJECTIVE: To describe health care service utilization and cost for decedents with and without amyotrophic lateral sclerosis (ALS) in the last year of life. METHODS: Using linked health administrative data, we conducted a retrospective, population-based cohort study of Ontario, Canada, decedents from 2013 to 2015. We examined demographic data, rate of utilization, and cost of health care services in the last year of life. RESULTS: We identified 283,096 decedents in Ontario, of whom 1,212 (0.42%) had ALS. Decedents with ALS spent 3 times as many days in an intensive care unit (ICU) (mean 6.3 vs 2.1, p < 0.001), and twice as many days using complex continuing care (mean 12.7 vs 6.0, p < 0.001) and home care (mean 99.1 vs 41.3, p < 0.001). A greater percentage of decedents with ALS received palliative home care (44% vs 20%, p < 0.001) and palliative physician home visits (40% vs 18%, p < 0.001) than decedents without ALS. Among decedents with ALS, a palliative physician home visit in the last year of life was associated with reduced adjusted odds of dying in hospital (odds ratio 0.65, 95% confidence interval 0.48-0.89) and fewer days spent in the ICU. Mean cost of care in the last year of life was greater for those with ALS ($68,311.98 vs $55,773.48, p < 0.001). CONCLUSIONS: In this large population-based cohort of decedents, individuals with ALS spent more days in the ICU, received more community-based services, and incurred higher costs of care in the last year of life. A palliative care physician home visit was associated with improved end of life outcomes; however, the majority of patients with ALS did not access such services.
OBJECTIVE: To describe health care service utilization and cost for decedents with and without amyotrophic lateral sclerosis (ALS) in the last year of life. METHODS: Using linked health administrative data, we conducted a retrospective, population-based cohort study of Ontario, Canada, decedents from 2013 to 2015. We examined demographic data, rate of utilization, and cost of health care services in the last year of life. RESULTS: We identified 283,096 decedents in Ontario, of whom 1,212 (0.42%) had ALS. Decedents with ALS spent 3 times as many days in an intensive care unit (ICU) (mean 6.3 vs 2.1, p < 0.001), and twice as many days using complex continuing care (mean 12.7 vs 6.0, p < 0.001) and home care (mean 99.1 vs 41.3, p < 0.001). A greater percentage of decedents with ALS received palliative home care (44% vs 20%, p < 0.001) and palliative physician home visits (40% vs 18%, p < 0.001) than decedents without ALS. Among decedents with ALS, a palliative physician home visit in the last year of life was associated with reduced adjusted odds of dying in hospital (odds ratio 0.65, 95% confidence interval 0.48-0.89) and fewer days spent in the ICU. Mean cost of care in the last year of life was greater for those with ALS ($68,311.98 vs $55,773.48, p < 0.001). CONCLUSIONS: In this large population-based cohort of decedents, individuals with ALS spent more days in the ICU, received more community-based services, and incurred higher costs of care in the last year of life. A palliative care physician home visit was associated with improved end of life outcomes; however, the majority of patients with ALS did not access such services.
Authors: Kelly Fahrner-Scott; Carly Zapata; David L O'Riordan; Eve Cohen; Laura Rosow; Steven Z Pantilat; Catherine Lomen-Hoerth; Kara E Bischoff Journal: Neurol Clin Pract Date: 2022-02
Authors: Walter H Moos; Douglas V Faller; Ioannis P Glavas; David N Harpp; Iphigenia Kanara; Anastasios N Mavrakis; Julie Pernokas; Mark Pernokas; Carl A Pinkert; Whitney R Powers; Konstantina Sampani; Kosta Steliou; Demetrios G Vavvas; Robert J Zamboni; Krishna Kodukula; Xiaohong Chen Journal: Biores Open Access Date: 2020-03-31
Authors: Ahmad R Abuzinadah; Aysha A AlShareef; Abdullah AlKutbi; Ahmed K Bamaga; Ali Alshehri; Hussein Algahtani; Edward Cupler; Mohammed H Alanazy Journal: Brain Behav Date: 2020-08-15 Impact factor: 2.708