title: Transitions between care settings at the end of life in the Netherlands: results from a nationwide study.
abstract: Multiple transitions between care settings in the last phase of life could jeopardize continuity of care and overall end-of-life patient care. Using a mortality follow-back study, we examined the nature and prevalence of transitions between Dutch care settings in the last 3 months of life, and identified potential characteristics associated with them. During the 2-year study period, 690 registered patients died 'totally expectedly and non-suddenly'. These made 709 transitions in the last 3 months, which involved a hospital two times out of three, and covered 43 distinct care trajectories. The most frequent trajectory was home-to-hospital (48%). Forty-six percent experienced one or more transitions in their last month of life. Male gender, multi-morbidities, and absence of GP awareness of a patient's wish for place of death were associated with having a transition in the last 30 days of life; age of < or = 85 years, having an infection and the absence of a palliative-centred treatment goal were associated with terminal hospitalization for > or = 7 days. Although the majority of the 'totally expected and non-sudden' deaths occurred at home, transitions to hospitals were relatively frequent. To minimize abrupt or frequent transitions just before death, timely recognition of the palliative phase of dying is important.
authors.affiliation: Department of Public and Occupational Care, The EMGO Institute for Health and Care Research, VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. ebun.abarshi@vumc.nl
authors.forename: Ebun
authors.initials: E
authors.lastname: Abarshi
authors.forename: Michael
authors.initials: M
authors.lastname: Echteld
authors.forename: Lieve
authors.initials: L
authors.lastname: Van den Block
authors.forename: Gé
authors.initials: G
authors.lastname: Donker
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
authors.forename: Bregje
authors.initials: B
authors.lastname: Onwuteaka-Philipsen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D002648:Child; D002675:Child, Preschool; D003266:Continuity of Patient Care / Q000592:standards* / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000592:standards*; D005260:Female; D006699:Home Care Services / Q000592:standards*; D006738:Hospices / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009735:Nursing Homes / Q000706:statistics & numerical data; D012111:Residence Characteristics; D013727:Terminal Care / Q000592:standards; D055815:Young Adult