Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2016

Open Access 01-12-2016 | Research article

Determinants of aggregate length of hospital stay in the last year of life in Switzerland

Authors: Damian Hedinger, Julia Braun, Vladimir Kaplan, Matthias Bopp, for the Swiss National Cohort Study Group

Published in: BMC Health Services Research | Issue 1/2016

Login to get access

Abstract

Background

In contrast to individual preferences, most people in developed countries die in health care institutions, with a considerable impact on health care resource use and costs. However, evidence about determinants of aggregate length of hospital stay in the last year preceding death is scant.

Methods

Nationwide individual patient data from Swiss hospital discharge statistics were linked with census and mortality records from the Swiss National Cohort. We explored determinants of aggregate length of hospital stay in the last year of life in N = 35,598 inpatients ≥65 years who deceased in 2007 or 2008.

Results

The average aggregate length of hospital stay in the last year of life was substantially longer in the German speaking region compared to the French (IRR 1.36 [95 % CI 1.32–1.40]) and Italian (IRR 1.22 [95 % CI 1.16–1.29]) speaking region of the country. Increasing age, female sex, multimorbidity, being divorced, foreign nationality, and high educational level prolonged, whereas home ownership shortened the aggregate length of hospital stay. Individuals with complementary private health insurance plans had longer stays than those with compulsory health insurance plans (IRR 1.04 [95 % CI 1.01–1.07]).

Conclusions

The aggregate length of hospital stay during the last year of life was substantially determined by regional and socio-demographic characteristics, and only partially explained by differential health conditions. Therefore, more detailed studies need to evaluate, whether these differences are based on patients’ health care needs and preferences, or whether they are supply-driven.
Appendix
Available only for authorised users
Literature
1.
2.
Schäfer I, von Leitner E-C, Schön G, Koller D, Hansen H, Kolonko T, et al. Multimorbidity patterns in the elderly: a new approach of disease clustering identifies complex interrelations between chronic conditions. PLoS One. 2010;5(12):e15941.CrossRefPubMedPubMedCentral
3.
Broad JB, Gott M, Kim H, Boyd M, Chen H, Connolly MJ. Where do people die? An international comparison of the percentage of deaths occurring in hospital and residential aged care settings in 45 populations, using published and available statistics. Int J Public Health. 2013;58(2):257–67.CrossRefPubMed
4.
Cohen J, Bilsen J, Addington-Hall J, Löfmark R, Miccinesi G, Kaasa S, et al. Population-based study of dying in hospital in six European countries. Palliat Med. 2008;22(6):702–10.CrossRefPubMed
5.
Busse R, Krauth C, Schwartz FW. Use of acute hospital beds does not increase as the population ages: results from a seven year cohort study in Germany. J Epidemiol Community Health. 2002;56(4):289–93.CrossRefPubMedPubMedCentral
6.
Polder JJ, Barendregt JJ, van Oers H. Health care costs in the last year of life - The Dutch experience. Soc Sci Med. 2006;63:1720–31.CrossRefPubMed
7.
Reich O, Signorell A, Busato A. Place of death and health care utilization for people in the last 6 months of life in Switzerland: a retrospective analysis using administrative data. BMC Health Serv Res. 2013;13:116.CrossRefPubMedPubMedCentral
8.
Hoover DR, Crystal S, Kumar R, Sambamoorthi U, Cantor JC. Medical expenditures during the last year of life: findings from the 1992–1996 medicare current beneficiary survey. Health Serv Res. 2002;37(6):1625–42.CrossRefPubMedPubMedCentral
9.
Curtis JR, Engelberg RA, Bensink ME, Ramsey SD. End-of-life care in the intensive care unit: can we simultaneously increase quality and reduce costs? Am J Respir Crit Care Med. 2012;186(7):587–92.CrossRefPubMedPubMedCentral
10.
Wanless D. Securing our future health: taking a long-term view. final report. London: The Public Enquiry Unit; 2002.
11.
12.
Wilson DM, Thurston A, Lichlyter B. Should the oldest-old be admitted to the intensive care unit and receive advanced life-supporting care? Crit Care Med. 2010;38(1):303–4.CrossRefPubMed
13.
Teno JM, Gozalo PL, Bynum JPW, Leland NE, Miller SC, Morden NE, et al. Change in end-of-life care for medicare beneficiaries. Site of death, place of care, and health care transitions in 2000, 2005, and 2009. JAMA J Am Med Assoc. 2013;309(5):470–7.CrossRef
14.
Boumendil A, Angus DC, Guitonneau AL, Menn AM, Ginsburg C, Takun K, et al. Variability of intensive care admission decisions for the very elderly. PLoS One. 2012;7(4):10–8.CrossRef
15.
Hinkle LJ, Bosslet GT, Torke AM. Factors associated with family satisfaction with End-of-life care in the ICU. Chest J. 2015;147(1):82.CrossRef
16.
Martikainen P, Murphy M, Metsä-Simola N, Häkkinen U, Moustgaard H. Seven-year hospital and nursing home care use according to age and proximity to death: variations by cause of death and socio-demographic position. J Epidemiol Community Health. 2012;66(12):1152–8.CrossRefPubMed
17.
Mackenbach JP, Stirbu I, Roskam A-J, Schaap MM, Menivelle G, Leinsalu M, et al. Socioeconomic inequalities in health in 22 European Countries. N Engl J Med. 2008;358:2468–81.CrossRefPubMed
18.
Faeh D, Bopp M. Educational inequalities in mortality and associated risk factors: German- versus French-speaking Switzerland. BMC Public Health. 2010;10:567.CrossRefPubMedPubMedCentral
19.
Huisman M, Kunst AE, Bopp M, Borgan J-K, Borrell C, Costa G, et al. Educational inequalities in cause-specific mortality in middle-aged and older men and women in eight western European populations. Lancet. 2005;365(9458):493–500.CrossRefPubMed
20.
Hedinger D, Braun J, Zellweger U, Kaplan V, Bopp M. Moving to and dying in a nursing home depends not only on health - An analysis of socio-Demographic Determinants of Place of Death in Switzerland. PLoS One. 2014;9(11):e113236.CrossRefPubMedPubMedCentral
21.
Beng AKL, Fong CW, Shum E, Goh CR, Goh KT, Chew SK. Where the elderly die: the influence of socio-demographic factors and cause of death on people dying at home. Ann Acad Med. 2009;38(8):676–83.
22.
Goodman DC, Elliott FS, Chang C. After hospitalization: a Dartmouth atlas report on post-acute care for medicare beneficiaries. The Darthmouth atlas project. 2011.
23.
Insam C, Paccaud F, Marques-Vidal P. The region makes the difference: disparities in management of acute myocardial infarction within Switzerland. Eur J Prev Cardiol. 2014;21:541–8.CrossRefPubMed
24.
Bopp M, Spoerri A, Zwahlen M, Gutzwiller F, Paccaud F, Braun-Fahrländer C, et al. Cohort profile: the Swiss National Cohort-a longitudinal study of 6.8 million people. Int J Epidemiol. 2009;38(2):379–84.CrossRefPubMed
25.
Swiss Federal Statistical Office. Medizinische Statistik der Krankenhäuser 2011 - Standardtabellen. Neuenburg: Swiss Federal Statistical Office; 2013.
26.
Hedinger D, Haemmig O, Braun J, Bopp M. Social determinants of duration of last nursing home stay at the end of life in Switzerland: a retrospective cohort study. BMC Geriatrics 2015;15:114.
27.
O’Halloran J, Miller GC, Britt H. Defining chronic conditions for primary care with ICPC-2. Fam Pract. 2004;21(4):381–6.CrossRefPubMed
28.
Hilbe JM. Negative binomial regression. Cambridge: Cambridge University Press; 2007.CrossRef
29.
Fischer S, Bosshard G, Faisst K, Tschopp A, Fischer J, Bär W, et al. Swiss doctors’ attitudes towards end-of-life decisions and their determinants. A comparison of three language regions. Swiss Med Wkly. 2005;135:370–6.
30.
Ishikawa Y, Fukui S, Saito T, Fujita J, Watanabe M, Yoshiuchi K. Family preference for place of death mediates the relationship between patient preference and actual place of death: a nationwide retrospective cross-sectional study. PLoS One. 2013;8(3):e56848.CrossRefPubMedPubMedCentral
31.
Teno JM, Clarridge BR, Casey V, Welch LC, Wetle T, Shield R, et al. Family perspectives on end-of-life care at the last place of care. JAMA J Am Med Assoc. 2004;291(1):88–93.CrossRef
32.
Van den Block L, Deschepper R, Drieskens K, Bauwens S, Bilsen J, Bossuyt N, et al. Hospitalisations at the end of life: using a sentinel surveillance network to study hospital use and associated patient, disease and healthcare factors. BMC Health Serv Res. 2007;7:69.CrossRefPubMed
33.
Gomes B, Calanzani N, Curiale V, Mccrone P, Higginson I. Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Cochrane Database Syst Rev. 2014;6:CD007760.
34.
Miccinesi G, Crocetti E, Morino P, Fallai M, Piazza M, Cavallini V, et al. Palliative home care reduces time spent in hospital wards: a population-based study in the Tuscany Region, Italy. Cancer Causes Control. 2003;14(10):971–7.CrossRefPubMed
35.
Centeno C, Clark D, Lynch T, Racafort J, Praill D, De Lima L, et al. Facts and indicators on palliative care development in 52 countries of the WHO European region: results of an EAPC task force. Palliat Med. 2007;21(6):463–71.CrossRefPubMed
36.
Baker M, Luce J, Bosslet GT. Integration of palliative care services in the intensive care unit. Clin Chest Med. 2015;36(3):441–8. Elsevier Inc.CrossRefPubMed
37.
Swiss Federal Statistical Office. Inventar der Datensituation über Palliative Care. Neuenburg: Swiss Federal Statistical Office; 2012.
38.
Bayer-Oglesby L, Höpflinger F. Statistische Grundlagen zur regionalen Pflegeheimplanung in der Schweiz. Methodik und kantonale Kennzahlen. Neuenburg: Obsan; 2010.
39.
Fischer S, Bosshard G, Zellweger U, Faisst K. Der Sterbeort: “Wo sterben die Menschen heute in der Schweiz?”. Z Gerontol Geriatr. 2004;37(6):467–74.CrossRefPubMed
Metadata
Title
Determinants of aggregate length of hospital stay in the last year of life in Switzerland
Authors
Damian Hedinger
Julia Braun
Vladimir Kaplan
Matthias Bopp
for the Swiss National Cohort Study Group
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2016
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-016-1725-7

Other articles of this Issue 1/2016

BMC Health Services Research 1/2016 Go to the issue

Research article

Utilization patterns of insulin therapy and healthcare services among Japanese insulin initiators during their first year: a descriptive analysis of administrative hospital data

Research article

Predictors of dentists’ behaviours in delivering prevention in primary dental care in England: using the theory of planned behaviour

Research article

Cost analysis of multiple sclerosis in Brazil: a cross-sectional multicenter study

Research article

Interventions for healthcare providers to improve treatment and prevention of female genital mutilation: a systematic review

Research article

Causes of cancellations on the day of surgery at a Tertiary Teaching Hospital

Research article

Perceived coercion to enter treatment among involuntarily and voluntarily admitted patients with substance use disorders