Comprehensive Analysis of Mortality in a Hospital Center in the Year 2019 to 2020 and the Provision of Palliative Care in Current Medical Practice
Main Article Content
Hector de los Santos
http://orcid.org/0000-0001-6959-9814
Ricardo Martinez
http://orcid.org/0000-0002-7015-7949
http://orcid.org/0000-0001-6959-9814
Ricardo Martinez
http://orcid.org/0000-0002-7015-7949
Abstract
In this retrospective investigation carried out in a mutual hospital in Montevideo between 2019 and 2020, a quantitative and descriptive analysis of patients older than eighteen years of age who died during that period was carried out. The main objective was to examine the medical records of these patients during the six months prior to their death, using the NecPal 3.1 instrument to assess their clinical variables. The confidentiality and anonymization of the patient data were carefully protected, and a specific database was created for this study. The results obtained provided a detailed description of the patient population, their palliative needs and the quality of care at the end of their lives. The proposed working hypothesis maintained that palliative care did not reduce unnecessary hospital admissions, with a significance level (p) less than 0.05. During the period studied, 200 deaths were registered, with a predominance of women and a mean age of 73.6 years. Of these deceased, 136 had palliative needs, and of these, 50 were admitted to a palliative care unit. The results revealed that patients who did not receive palliative care experienced a greater number of hospital admissions compared to those who did. This led to rejecting the null hypothesis and demonstrating that palliative care had a significant preventive effect in terms of hospital admissions at the end of life.
Keywords:
Palliative care, Chronic diseases, Intensive care unit, Hospital admission, End-of-life care
Article Details
How to Cite
SANTOS, Hector de los; MARTINEZ, Ricardo.
Comprehensive Analysis of Mortality in a Hospital Center in the Year 2019 to 2020 and the Provision of Palliative Care in Current Medical Practice.
Medical Research Archives, [S.l.], v. 11, n. 9, sep. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4442>. Date accessed: 21 dec. 2024.
doi: https://doi.org/10.18103/mra.v11i9.4442.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Rabow MW, Hardie GE, Fair JM, McPhee SJ. End-of-life care content in 50 textbooks from multiple specialties. NEVER. 2000;283(6):771-778. doi:10.1001/jama.283.6.771
2. Lynn J. Perceptions by family members of the dying experience of older and seriously Ill patients. Ann Intern Med. 1997;126(2):97. doi:10.7326/0003-4819-126-2-199701150-00001
3. Gomes B, Calanzani N, Gysels M, Hall S, Higginson IJ. Heterogeneity and changes in preferences for dying at home: a systematic review. BMC Palliat Care. 2013;12(1). doi:10.1186/1472-684x-12-7
4. Pritchard RS, Fisher ES, Teno JM et al. Influence of patient preferences and local health system characteristics on the place of death. J Am Geriatric Soc. 1998;46(10):1242-1250. doi:10.1111/j.1532-5415.1998.tb04540.x
5. Pivodic L, Pardon K, Morin L et al. Place of death in the population dying from diseases indicative of palliative care need: a cross-national population-level study in 14 countries. J Epidemiology Community Health. 2015;70(1):17-24. doi:10.1136/jech-2014-205365
6. Basol N. The integration of palliative care into the emergency department. Turk J Emerg Med. 2015;15(2):100-107. doi:10.5505/1304.7361.2015.65983
7. Kraus CK, Greenberg MR, Ray DE, Dy SM. Palliative care education in emergency medicine residency training: a survey of program directors, associate program directors, and assistant program directors. J Pain Symptom Manager. 2016;51(5):898-906. doi:10.1016/j.jpainsymman.2015.12.334
8. Smith AK, McCarthy E, Weber E et al. Half of older Americans seen In emergency department In last month of life; most admitted to hospital, and many die there. Health Aff. 2012;31(6):1277-1285. doi:10.1377/hlthaff.2011.0922
9. Rondeau DF, Schmidt TA. Treating cancer patients who are near the end of life in the emergency department. Emerg Med Clin North Am. 2009;27(2):341-354. doi:10.1016/j.emc.2009.01.006
10. Noncommunicable diseases - PAHO/WHO | Pan American Health Organization. PAHO/WHO | Pan American Health Organization. Accessed August 29, 2023. https://www.paho.org/en/themes/noncommunicable-diseases
11. Solberg LM, Hincapie-Echeverri J. Palliative care in the emergency department. Crit Care Nurses Clin North Am. 2015;27(3):355-368. doi:10.1016/j.cnc.2015.05.008
12. Tripodoro Vilma A, Rynkiewicz María C, Llanos Victoria, Padova Susana, De Lellis Silvina, De Simone Gustavo. Palliative care in people with advanced chronic diseases. Medicine (B. Aires) [Internet]. 2016 Jun [cited 2023 Aug 31] ; 76(3): 139-147. Available at: http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S0025-76802016000300003&lng=es.
13. Iglesias ML, Lafuente A. Assistance to the dying patient who is going to die in the emergency room. An del Sist Sanit Navar. 2010;33. doi:10.4321/s1137-66272010000200018
14. .Rodríguez Maroto O, Llorente Álvarez S, Casanueva Gutiérrez M, Álvarez Álvarez B, Riva Miranda GD. Are hospital emergency services a suitable place to die? An Internal Medicine. 2004;21(12).
15. doi:10.4321/s0212-71992004001200004
16. González Barón M, Gómez Raposo C, Vilches Aguirre Y. Last stage of progressive neoplastic disease: care in agony, refractory symptoms and sedation. Clinical Medicine 2006;127(11):421-428. doi:10.1157/13092768
17. Paredes M. The demographic aging process in Uruguay and its challenges | ECLAC. Economic Commission for Latin America and the Caribbean. November 16, 2017. Accessed August 31, 2023.https://www.cepal.org/es/enfoques/proceso-vevejecimiento-demografico-uruguay-sus-desafios
18. Singer PA, Martin DK, Kelner M. Quality End-of-Life Care. NEVER. 1999;281(2):163. doi:10.1001/jama.281.2.163
19. Quiñones Pérez A, Álvarez Jiménez P, García Sánchez MJ, Guardia Mancilla P. Influence of advanced care in palliative care on frequenting hospital emergencies. Palliative Medicine. 2013;20(2):60-63. doi:10.1016/j.medipa.2012.07.003
20. Seow H, Sutradhar R, Barbera LC et al. Does early palliative care reduce end-of-life hospital costs? a propensity-score matched, population-based, cohort study. J Clin Oncol. 2021;39(15_suppl):12006. doi:10.1200/jco.2021.39.15_suppl.12006
21. Khandelwal N, Kross EK, Engelberg RA, Coe NB, Long AC, Curtis JR. Estimating the effect of palliative care interventions and advance care planning on ICU utilization. Crit Care Med. 2015;43(5):1102-1111. doi:10.1097/ccm.0000000000000852
22. Basol N. The integration of palliative care into the emergency department. Turk J Emerg Med. 2015;15(2):100-107. doi:10.5505/1304.7361.2015.65983
23. Troncoso J, Morales-Meyer T, Villarroel L, Turrillas P, Rodríguez-Nuñez A. Adaptation and validation in Chile of the instrument for identifying patients in need of palliative care: NECPAL-CCOMS-ICO 3.1©. Primary Care. 2021;53(4):101994. doi:10.1016/j.apr.2021.101994
24. Aslam M, Imdad Ullah M. R language: introduction. In: Practicing R for Statistical Computing. Springer Nature Singapore; 2023:1-6. doi:10.1007/978-981-99-2886-6_1
25. McNamara B, Rosenwax LK, Holman CD. A method for defining and estimating the palliative care population. J Pain Symptom Manager. 2006;32(1):5-12. doi:10.1016/j.jpainsymman.2005.12.018
26. Basol N, Celtek N, Alatli T, Koc I, Suren M. Evaluation of terminal-stage cancer patients needing palliative care in the emergency department. J Acad Emerg Med. 2015;14(1):12-15. doi:10.5152/jaem.2015.58672
27. Amado-Tineo JP, Che-Hidalgo E, Apolaya-Segura M et al. Analysis of health care costs for cancer patients at the end of life: hospital versus home with palliative care, at the third level of care. Rev Del Cuerpo Medico Hosp Nac Almanzor Aguinaga Asenjo. 2022;15(2):174-179. doi:10.35434/rcmhnaaa.2022.152.1071
28. Moreira E, Lamas L, Píriz Alvarez G, Barbato M, Burghi G. Assessment of consultation triggers to optimize the opportunity to access palliative care in the ICU. MEDICAL REV OF URUG. 2021;37(1). doi:10.29193/rmu.37.1.4
29. palliative care. World Health Organization (WHO). Accessed August 31, 2023. https://www.who.int/es/news-room/fact-sheets/detail/palliative-care
30. Hua MS, Li G, Blinderman CD, Wunsch H. Estimates of the need for palliative care consultation across united states intensive care units using a trigger-based model. Am J Respir Crit Care Med. 2014;189(4):428-436. doi:10.1164/rccm.201307-1229oc
31. O'Mahony S, McHenry J, Blank AE et al. Preliminary report of the integration of a palliative care team into an intensive care unit. Palliat Med. 2009;24(2):154-165. doi:10.1177/0269216309346540
32. Salama H, Al Mutairi N, Damlaj M et al. Reducing futile acute care services for terminally ill patients with cancer: the dignity project. JCO Oncol Pract. 2021: OP.20.00922. doi:10.1200/op.20.00922
33. Penrod JD, Deb P, Dellenbaugh C et al. Hospital-based palliative care consultation: effects on hospital cost. J Palliat Med. 2010;13(8):973-979. doi:10.1089/jpm.2010.0038
34. Nipp R, El-Jawahri A, Traeger L. Factors associated with place of death in patients with advanced cancer and receiving palliative care. J Palliat Med. 2020;23(9):115-116.
35. May P, Normand C, Cassel JB et al. Economics of palliative care for hospitalized adults with serious illness. JAMA Intern Med. 2018;178(6):820. doi:10.1001/jamainternmed.2018.0750
36. Bird A, Leach S, Houck S, Robinson K, Lawson T. UT southwestern's palliative care program: measurable patient impact and cost-savings. J Pain Amp Palliat Care Pharmacother. 2018;32(4):212-215. doi:10.1080/15360288.2019.1624675
37. Sessa C, Roggero E, Pampallona S et al. The last 3 months of life of cancer patients: Medical aspects and role of home-care services in southern Switzerland. Support Care Cancer. 1996;4(3):180-185. doi:10.1007/bf01682337
38. Escalón González AM, Escobar Chávez EJ. Palliative care and its influence on the quality of life of patients with heart failure. Alert Rev Scient Of The Inst Nac Salud. 2022;5(1):74-80. doi:10.5377/alert.v5i1.12658
39. Huo B, Song Y, Chang L, Tan B. Effects of early palliative care on patients with incurable cancer: a goal‐analysis and systematic review. Eur J Cancer Care. 2022. doi:10.1111/ecc.13620
40. Bajwah S, Oluyase AO, Yi D et al. The effectiveness and cost-effectiveness of hospital-based specialist palliative care for adults with advanced illness and their caregivers. Cochrane Database Syst Rev. 2020. doi:10.1002/14651858.cd012780.pub2
41. Oluyase AO, Higginson IJ, Yi D et al. Hospital-based specialist palliative care compared with usual care for adults with advanced illness and their caregivers: a systematic review. Health Serv Deliv Res. 2021;9(12):1-218. doi:10.3310/hsdr09120
42. Raftery J, Addington-Hall J, MacDonald L et al. A randomized controlled trial of the cost-effectiveness of a district coordinating service for terminally ill cancer patients. Palliat Med. 1996;10(2):151-161. doi:10.1177/026921639601000210
2. Lynn J. Perceptions by family members of the dying experience of older and seriously Ill patients. Ann Intern Med. 1997;126(2):97. doi:10.7326/0003-4819-126-2-199701150-00001
3. Gomes B, Calanzani N, Gysels M, Hall S, Higginson IJ. Heterogeneity and changes in preferences for dying at home: a systematic review. BMC Palliat Care. 2013;12(1). doi:10.1186/1472-684x-12-7
4. Pritchard RS, Fisher ES, Teno JM et al. Influence of patient preferences and local health system characteristics on the place of death. J Am Geriatric Soc. 1998;46(10):1242-1250. doi:10.1111/j.1532-5415.1998.tb04540.x
5. Pivodic L, Pardon K, Morin L et al. Place of death in the population dying from diseases indicative of palliative care need: a cross-national population-level study in 14 countries. J Epidemiology Community Health. 2015;70(1):17-24. doi:10.1136/jech-2014-205365
6. Basol N. The integration of palliative care into the emergency department. Turk J Emerg Med. 2015;15(2):100-107. doi:10.5505/1304.7361.2015.65983
7. Kraus CK, Greenberg MR, Ray DE, Dy SM. Palliative care education in emergency medicine residency training: a survey of program directors, associate program directors, and assistant program directors. J Pain Symptom Manager. 2016;51(5):898-906. doi:10.1016/j.jpainsymman.2015.12.334
8. Smith AK, McCarthy E, Weber E et al. Half of older Americans seen In emergency department In last month of life; most admitted to hospital, and many die there. Health Aff. 2012;31(6):1277-1285. doi:10.1377/hlthaff.2011.0922
9. Rondeau DF, Schmidt TA. Treating cancer patients who are near the end of life in the emergency department. Emerg Med Clin North Am. 2009;27(2):341-354. doi:10.1016/j.emc.2009.01.006
10. Noncommunicable diseases - PAHO/WHO | Pan American Health Organization. PAHO/WHO | Pan American Health Organization. Accessed August 29, 2023. https://www.paho.org/en/themes/noncommunicable-diseases
11. Solberg LM, Hincapie-Echeverri J. Palliative care in the emergency department. Crit Care Nurses Clin North Am. 2015;27(3):355-368. doi:10.1016/j.cnc.2015.05.008
12. Tripodoro Vilma A, Rynkiewicz María C, Llanos Victoria, Padova Susana, De Lellis Silvina, De Simone Gustavo. Palliative care in people with advanced chronic diseases. Medicine (B. Aires) [Internet]. 2016 Jun [cited 2023 Aug 31] ; 76(3): 139-147. Available at: http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S0025-76802016000300003&lng=es.
13. Iglesias ML, Lafuente A. Assistance to the dying patient who is going to die in the emergency room. An del Sist Sanit Navar. 2010;33. doi:10.4321/s1137-66272010000200018
14. .Rodríguez Maroto O, Llorente Álvarez S, Casanueva Gutiérrez M, Álvarez Álvarez B, Riva Miranda GD. Are hospital emergency services a suitable place to die? An Internal Medicine. 2004;21(12).
15. doi:10.4321/s0212-71992004001200004
16. González Barón M, Gómez Raposo C, Vilches Aguirre Y. Last stage of progressive neoplastic disease: care in agony, refractory symptoms and sedation. Clinical Medicine 2006;127(11):421-428. doi:10.1157/13092768
17. Paredes M. The demographic aging process in Uruguay and its challenges | ECLAC. Economic Commission for Latin America and the Caribbean. November 16, 2017. Accessed August 31, 2023.https://www.cepal.org/es/enfoques/proceso-vevejecimiento-demografico-uruguay-sus-desafios
18. Singer PA, Martin DK, Kelner M. Quality End-of-Life Care. NEVER. 1999;281(2):163. doi:10.1001/jama.281.2.163
19. Quiñones Pérez A, Álvarez Jiménez P, García Sánchez MJ, Guardia Mancilla P. Influence of advanced care in palliative care on frequenting hospital emergencies. Palliative Medicine. 2013;20(2):60-63. doi:10.1016/j.medipa.2012.07.003
20. Seow H, Sutradhar R, Barbera LC et al. Does early palliative care reduce end-of-life hospital costs? a propensity-score matched, population-based, cohort study. J Clin Oncol. 2021;39(15_suppl):12006. doi:10.1200/jco.2021.39.15_suppl.12006
21. Khandelwal N, Kross EK, Engelberg RA, Coe NB, Long AC, Curtis JR. Estimating the effect of palliative care interventions and advance care planning on ICU utilization. Crit Care Med. 2015;43(5):1102-1111. doi:10.1097/ccm.0000000000000852
22. Basol N. The integration of palliative care into the emergency department. Turk J Emerg Med. 2015;15(2):100-107. doi:10.5505/1304.7361.2015.65983
23. Troncoso J, Morales-Meyer T, Villarroel L, Turrillas P, Rodríguez-Nuñez A. Adaptation and validation in Chile of the instrument for identifying patients in need of palliative care: NECPAL-CCOMS-ICO 3.1©. Primary Care. 2021;53(4):101994. doi:10.1016/j.apr.2021.101994
24. Aslam M, Imdad Ullah M. R language: introduction. In: Practicing R for Statistical Computing. Springer Nature Singapore; 2023:1-6. doi:10.1007/978-981-99-2886-6_1
25. McNamara B, Rosenwax LK, Holman CD. A method for defining and estimating the palliative care population. J Pain Symptom Manager. 2006;32(1):5-12. doi:10.1016/j.jpainsymman.2005.12.018
26. Basol N, Celtek N, Alatli T, Koc I, Suren M. Evaluation of terminal-stage cancer patients needing palliative care in the emergency department. J Acad Emerg Med. 2015;14(1):12-15. doi:10.5152/jaem.2015.58672
27. Amado-Tineo JP, Che-Hidalgo E, Apolaya-Segura M et al. Analysis of health care costs for cancer patients at the end of life: hospital versus home with palliative care, at the third level of care. Rev Del Cuerpo Medico Hosp Nac Almanzor Aguinaga Asenjo. 2022;15(2):174-179. doi:10.35434/rcmhnaaa.2022.152.1071
28. Moreira E, Lamas L, Píriz Alvarez G, Barbato M, Burghi G. Assessment of consultation triggers to optimize the opportunity to access palliative care in the ICU. MEDICAL REV OF URUG. 2021;37(1). doi:10.29193/rmu.37.1.4
29. palliative care. World Health Organization (WHO). Accessed August 31, 2023. https://www.who.int/es/news-room/fact-sheets/detail/palliative-care
30. Hua MS, Li G, Blinderman CD, Wunsch H. Estimates of the need for palliative care consultation across united states intensive care units using a trigger-based model. Am J Respir Crit Care Med. 2014;189(4):428-436. doi:10.1164/rccm.201307-1229oc
31. O'Mahony S, McHenry J, Blank AE et al. Preliminary report of the integration of a palliative care team into an intensive care unit. Palliat Med. 2009;24(2):154-165. doi:10.1177/0269216309346540
32. Salama H, Al Mutairi N, Damlaj M et al. Reducing futile acute care services for terminally ill patients with cancer: the dignity project. JCO Oncol Pract. 2021: OP.20.00922. doi:10.1200/op.20.00922
33. Penrod JD, Deb P, Dellenbaugh C et al. Hospital-based palliative care consultation: effects on hospital cost. J Palliat Med. 2010;13(8):973-979. doi:10.1089/jpm.2010.0038
34. Nipp R, El-Jawahri A, Traeger L. Factors associated with place of death in patients with advanced cancer and receiving palliative care. J Palliat Med. 2020;23(9):115-116.
35. May P, Normand C, Cassel JB et al. Economics of palliative care for hospitalized adults with serious illness. JAMA Intern Med. 2018;178(6):820. doi:10.1001/jamainternmed.2018.0750
36. Bird A, Leach S, Houck S, Robinson K, Lawson T. UT southwestern's palliative care program: measurable patient impact and cost-savings. J Pain Amp Palliat Care Pharmacother. 2018;32(4):212-215. doi:10.1080/15360288.2019.1624675
37. Sessa C, Roggero E, Pampallona S et al. The last 3 months of life of cancer patients: Medical aspects and role of home-care services in southern Switzerland. Support Care Cancer. 1996;4(3):180-185. doi:10.1007/bf01682337
38. Escalón González AM, Escobar Chávez EJ. Palliative care and its influence on the quality of life of patients with heart failure. Alert Rev Scient Of The Inst Nac Salud. 2022;5(1):74-80. doi:10.5377/alert.v5i1.12658
39. Huo B, Song Y, Chang L, Tan B. Effects of early palliative care on patients with incurable cancer: a goal‐analysis and systematic review. Eur J Cancer Care. 2022. doi:10.1111/ecc.13620
40. Bajwah S, Oluyase AO, Yi D et al. The effectiveness and cost-effectiveness of hospital-based specialist palliative care for adults with advanced illness and their caregivers. Cochrane Database Syst Rev. 2020. doi:10.1002/14651858.cd012780.pub2
41. Oluyase AO, Higginson IJ, Yi D et al. Hospital-based specialist palliative care compared with usual care for adults with advanced illness and their caregivers: a systematic review. Health Serv Deliv Res. 2021;9(12):1-218. doi:10.3310/hsdr09120
42. Raftery J, Addington-Hall J, MacDonald L et al. A randomized controlled trial of the cost-effectiveness of a district coordinating service for terminally ill cancer patients. Palliat Med. 1996;10(2):151-161. doi:10.1177/026921639601000210