Choosing and Doing Wisely: Triage Level I Resuscitation a Possible New Field for Starting Palliative Care and Avoiding Low-value Care - a Nationwide Matched-pair Retrospective Cohort Study in Taiwan

Overview

Journal BMC Palliat Care

Publisher Biomed Central

Specialty Critical Care

Date 2020 Jun 22

PMID 32563245

Citations 1

Authors

Chih-Yuan Lin

Yue-Chune Lee

Affiliations

Soon will be listed here.

Abstract

Background: The association between palliative care and life-sustaining treatment following emergency department (ED) resuscitation is unclear. This study aims to analyze the usage of palliative care and life-sustaining treatments among ED triage level I resuscitation patients based on a nationally representative sample of patients in Taiwan.

Methods: A matched-pair retrospective cohort study was conducted to examine the association between palliative care and outcome variables using multivariate logistic regression and Kaplan-Meier survival analyses. Between 2009 and 2013, 336 ED triage level I resuscitation patients received palliative care services (palliative care group) under a universal health insurance scheme. Retrospective cohort matching was performed with those who received standard care at a ratio of 1:4 (usual care group). Outcome variables included the number of visits to emergency and outpatient departments, hospitalization duration, total medical expenses, utilization of life-sustaining treatments, and duration of survival following ED triage level I resuscitation.

Results: The mean survival duration following level I resuscitation was less than 1 year. Palliative care was administered to 15% of the resuscitation cohort. The palliative care group received significantly less life-sustaining treatment than did the usual care group.

Conclusion: Among patients who underwent level I resuscitation, palliative care was inversely correlated with the scope of life-sustaining treatments. Furthermore, triage level I resuscitation status may present a possible new field for starting palliative care intervention and reducing low-value care.

Citing Articles

Influence of Hospice Palliative Care on Medical Service Usage in Prolonged Mechanical Ventilation Cases: A Nationwide Cohort Study.

Liu C, Chu Y, Chu C, Kung P, Huang H, Tsai W Respir Care. 2024; 69(12):1523-1533.

PMID: 39256001 PMC: 11572984. DOI: 10.4187/respcare.11587.

References

Spilsbury K, Rosenwax L . Community-based specialist palliative care is associated with reduced hospital costs for people with non-cancer conditions during the last year of life. BMC Palliat Care. 2017; 16(1):68. PMC: 5721619. DOI: 10.1186/s12904-017-0256-2. View

McMahan R, Knight S, Fried T, Sudore R . Advance care planning beyond advance directives: perspectives from patients and surrogates. J Pain Symptom Manage. 2012; 46(3):355-65. PMC: 4111444. DOI: 10.1016/j.jpainsymman.2012.09.006. View

Clarfield A, Monette J, Bergman H, Monette M, Ben-Israel Y, Caine Y . Enteral feeding in end-stage dementia: a comparison of religious, ethnic, and national differences in Canada and Israel. J Gerontol A Biol Sci Med Sci. 2006; 61(6):621-7. DOI: 10.1093/gerona/61.6.621. View

Rifkin D . Feeding the hungry ghosts. Am J Kidney Dis. 2010; 55(1):A33-4. DOI: 10.1053/j.ajkd.2009.11.003. View

Afshar K, Geiger K, Muller-Mundt G, Bleidorn J, Schneider N . [Generalist palliative care for non-cancer patients: A review article]. Schmerz. 2015; 29(6):604-15. DOI: 10.1007/s00482-015-0054-9. View

Van Lancker A, Van Hecke A, Verhaeghe S, Mattheeuws M, Beeckman D . A comparison of symptoms in older hospitalised cancer and non-cancer patients in need of palliative care: a secondary analysis of two cross-sectional studies. BMC Geriatr. 2018; 18(1):40. PMC: 5800068. DOI: 10.1186/s12877-018-0721-7. View

Lin Y, Hsu H, Lai T, Chiang W, Lin S, Chen Y . Emergency department utilization and resuscitation rate among patients receiving maintenance hemodialysis. J Formos Med Assoc. 2019; 118(12):1652-1660. DOI: 10.1016/j.jfma.2019.01.007. View

Lin L, Warren-Gash C, Smeeth L, Chen P . Data resource profile: the National Health Insurance Research Database (NHIRD). Epidemiol Health. 2019; 40:e2018062. PMC: 6367203. DOI: 10.4178/epih.e2018062. View

Cardona-Morrell M, Kim J, Turner R, Anstey M, Mitchell I, Hillman K . Non-beneficial treatments in hospital at the end of life: a systematic review on extent of the problem. Int J Qual Health Care. 2016; 28(4):456-69. DOI: 10.1093/intqhc/mzw060. View

10.

Kang S, Lin C, Chen Y, Wang W . The Impact of Hemodialysis on Terminal Cancer Patients in Hospices: A Nationwide Retrospective Study in Taiwan. J Palliat Med. 2019; 22(2):188-192. DOI: 10.1089/jpm.2018.0299. View

11.

Shao Y, Hsiue E, Hsu C, Yao C, Chen H, Lai M . National Policies Fostering Hospice Care Increased Hospice Utilization and Reduced the Invasiveness of End-of-Life Care for Cancer Patients. Oncologist. 2017; 22(7):843-849. PMC: 5507639. DOI: 10.1634/theoncologist.2016-0367. View

12.

Wu T, Majeed A, Kuo K . An overview of the healthcare system in Taiwan. London J Prim Care (Abingdon). 2015; 3(2):115-9. PMC: 3960712. DOI: 10.1080/17571472.2010.11493315. View

13.

Ong M, Shin S, De Souza N, Tanaka H, Nishiuchi T, Song K . Outcomes for out-of-hospital cardiac arrests across 7 countries in Asia: The Pan Asian Resuscitation Outcomes Study (PAROS). Resuscitation. 2015; 96:100-8. DOI: 10.1016/j.resuscitation.2015.07.026. View

14.

Chen B, Kuo C, Huang N, Fan V . Reducing costs at the end of life through provider incentives for hospice care: A retrospective cohort study. Palliat Med. 2018; 32(8):1389-1400. DOI: 10.1177/0269216318774899. View

15.

Su C, Wu J, Yang M, Liao C, Hsu H, Chang C . Demographics and Clinical Features of Postresuscitation Comorbidities in Long-Term Survivors of Out-of-Hospital Cardiac Arrest: A National Follow-Up Study. Biomed Res Int. 2017; 2017:9259182. PMC: 5327773. DOI: 10.1155/2017/9259182. View

16.

Fernandes C, Tanabe P, Gilboy N, Johnson L, McNair R, Rosenau A . Five-level triage: a report from the ACEP/ENA Five-level Triage Task Force. J Emerg Nurs. 2005; 31(1):39-50. DOI: 10.1016/j.jen.2004.11.002. View

17.

Huang C, Chen W, Chang W, Lai C, Lee Y . Factors influencing the outcomes after in-hospital resuscitation in Taiwan. Resuscitation. 2002; 53(3):265-70. DOI: 10.1016/s0300-9572(02)00024-2. View

18.

Blanch L, Abillama F, Amin P, Christian M, Joynt G, Myburgh J . Triage decisions for ICU admission: Report from the Task Force of the World Federation of Societies of Intensive and Critical Care Medicine. J Crit Care. 2016; 36:301-305. DOI: 10.1016/j.jcrc.2016.06.014. View

19.

Hsieh C, Su C, Shao S, Sung S, Lin S, Kao Yang Y . Taiwan's National Health Insurance Research Database: past and future. Clin Epidemiol. 2019; 11:349-358. PMC: 6509937. DOI: 10.2147/CLEP.S196293. View

20.

Stiel S, Matthies D, Seuss D, Walsh D, Lindena G, Ostgathe C . Symptoms and problem clusters in cancer and non-cancer patients in specialized palliative care-is there a difference?. J Pain Symptom Manage. 2014; 48(1):26-35. DOI: 10.1016/j.jpainsymman.2013.08.018. View