Trend Analysis of Palliative Care Utilization in Patients with Chronic Obstructive Pulmonary Disease During Hospitalization from 2007 to 2018 in Taiwan

Abstract

Li-Ting Kao,1 Shian-Chin Ko,2 Ping-Jen Chen,3,4 Yu-Cih Wu,5 Kuang-Ming Liao,6 Yi-Shan Liang,1 Chung-Han Ho,5,7,8 Fu-Wen Liang9– 11 1Department of Respiratory Therapy, Chi Mei Medical Center, Tainan, Taiwan; 2Center for Palliative Care, Chi Mei Medical Center, Tainan, Taiwan; 3Department of Family Medicine and Division of Geriatrics and Gerontology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 4School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 5Department of Medical Research, Chi Mei Medical Center, Tainan City, Taiwan; 6Department of Internal Medicine, Chi Mei Medical Center, Chiali, Tainan, Taiwan; 7Department of Information Management, Southern Taiwan University of Science and Technology, Tainan City, Taiwan; 8Cancer Center, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, Taiwan; 9Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan; 10Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 11Center for Big Data Research, Kaohsiung Medical University, Kaohsiung, TaiwanCorrespondence: Chung-Han Ho, Department of Medical Research, Chi Mei Medical Center, No. 901, Zhonghua Road Yongkang District, Tainan City, 71004, Taiwan, Tel [phone], Email [email protected] Fu-Wen Liang, Department of Public Health, College of Health Sciences, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Sanmin District, Kaohsiung, 807, Taiwan, Tel [phone] Ext 2786, Fax [phone], Email [email protected]: Palliative care utilization among hospitalized patients with advanced chronic obstructive pulmonary disease (COPD) in Taiwan remains low despite its costs making it eligible for reimbursement since 2009. Few studies have examined the trends of palliative care utilization. We analyzed the annual rate, associated factors, and timing of the inpatient palliative care utilization by hospitalized patients with COPD.Patients and Methods: We conducted a cross-sectional observational study between 1 January 2007 and 31 December 2018. Population-based claims data were extracted from Taiwan’s National Health Insurance Research Database to identify patients aged ≧40 years with COPD five years before the first instance of inpatient palliative care utilization.Results: There were 24,502 patients with COPD receiving inpatient palliative care. Our results indicated that older age, concomitant chronic conditions—especially cancer—and severity of comorbidities were associated with a higher rate of palliative care utilization by hospitalized patients with chronic obstructive pulmonary disease. In our study, the proportion of hospitalized patients with COPD receiving inpatient palliative care and having a Charlson comorbidity index score of 1– 2 was lower than that of patients with cancer and a Charlson comorbidity index score ≧3 during the 12-year study-observation period. In addition, approximately 50% of hospitalized patients with COPD received palliative care within 18 months after their initial admission for COPD during the study period. However, individuals with a CCI score of 1– 2 exhibited a slower entry into palliative care, with nearly 50% initiating it within the first two years.Conclusion: Inpatient palliative care utilization by hospitalized patients with advanced COPD remains low due to various causes. Our findings highlight that palliative care may be considered by professional care providers as routine care and as a way to manage problematic symptoms during hospitalization.Keywords: cancer comorbidity, inpatient care, joinpoint regression, Taiwan’s health insurance database

Keywords

• cancer comorbidity
• inpatient care
• joinpoint regression
• taiwan’s health insurance database