title: Health care utilization of patients with chronic obstructive pulmonary disease and lung cancer in the last 12 months of life.
abstract: BACKGROUND
  Previous studies have documented similar levels of end-of-life symptom burden for lung cancer and chronic obstructive pulmonary disease (COPD) patients, yet there has been little comparison of health care utilization during this period. This study contrasts health care utilization by people with COPD and those with lung cancer in the 12 months prior to death.
  
  
  METHODS
  We performed a retrospective cohort study of 1098 patients who died in 2004 with a cause of death recorded as COPD or lung cancer using administrative health data. Our outcomes of interest included acute, long-term and home care service utilization.
  
  
  RESULTS
  The study population was 42% female with a mean age of 77 years (S.D.=11). In the last 12 months of life, decedents with COPD were more likely to be institutionalized in a LTC setting (41% vs. 12.5%, p<0.05) and to receive long-term home care (26% vs. 9.7%, p<0.05), but were much less likely to receive palliative care in hospital (47.6% vs. 5.1%, p<0.001) or at home (37.4% vs. 2.8%, p<0.05) than people with lung cancer. In contrast, decedents with lung cancer made greater use of acute care services than those with COPD in that they were more likely to be hospitalized (94.2% vs. 80.4%, p<0.05) and had longer median LOS (7.0 vs. 5.7 days, p<0.05) than those with COPD. No differences in the number of out-patient physician visits were noted.
  
  
  CONCLUSIONS
  Patterns of end-of-life health care utilization differ significantly between people with lung cancer and those with COPD. Further research is needed to establish need and determine gaps in services to better address the needs of people dying with COPD.
authors.affiliation: College of Nursing, University of Saskatchewan, Sask., Canada S7N 5E5. donna.goodridge@usask.ca <donna.goodridge@usask.ca>
authors.forename: Donna
authors.initials: D
authors.lastname: Goodridge
authors.forename: Josh
authors.initials: J
authors.lastname: Lawson
authors.forename: Wendy
authors.initials: W
authors.lastname: Duggleby
authors.forename: Darcy
authors.initials: D
authors.lastname: Marciniuk
authors.forename: Donna
authors.initials: D
authors.lastname: Rennie
authors.forename: MaryRose
authors.initials: M
authors.lastname: Stang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006302:Health Services Research; D006699:Home Care Services / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008175:Lung Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012189:Retrospective Studies; D012525:Saskatchewan; D013727:Terminal Care / Q000706:statistics & numerical data*