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Transitions between care settings at the end of life in the Netherlands: results from a nationwide study

Research output: Contribution to journalJournal article

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  • Ebun Abarshi
  • Michael Echteld
  • Lieve Van den Block
  • Gé Donker
  • Luc Deliens
  • Bregje Onwuteaka-Philipsen
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<mark>Journal publication date</mark>03/2010
<mark>Journal</mark>Palliative Medicine
Issue number2
Volume24
Number of pages9
Pages (from-to)166-174
StatePublished
Original languageEnglish

Abstract

Multiple transitions between care settings in the last phase of life could jeopardize continuity of care and overall end-of-life patient care. Using a mortality follow-back study, we examined the nature and prevalence of transitions between Dutch care settings in the last 3 months of life, and identified potential characteristics associated with them. During the 2-year study period, 690 registered patients died 'totally expectedly and non-suddenly'. These made 709 transitions in the last 3 months, which involved a hospital two times out of three, and covered 43 distinct care trajectories. The most frequent trajectory was home-to-hospital (48%). Forty-six percent experienced one or more transitions in their last month of life. Male gender, multi-morbidities, and absence of GP awareness of a patient's wish for place of death were associated with having a transition in the last 30 days of life; age of <or = 85 years, having an infection and the absence of a palliative-centred treatment goal were associated with terminal hospitalization for > or = 7 days. Although the majority of the 'totally expected and non-sudden' deaths occurred at home, transitions to hospitals were relatively frequent. To minimize abrupt or frequent transitions just before death, timely recognition of the palliative phase of dying is important.