title: The utilization of hospice care among patients with motor neuron diseases: the experience in Taiwan from 2005 to 2010.
abstract: BACKGROUND
  The nature and extent of how patients with motor neuron diseases (MNDs) utilize hospice care in Taiwan remains unclear. This study aims to investigate the use of hospice care in Taiwan by patients with MND, and those factors that affect the extent, the cost, and the quality of their hospice treatment and care.
  
  
  METHODS
  We analyzed data from hospice care inpatient claims of MNDs, using the National Health Insurance Research Database of Taiwan during 2005-2010.
  
  
  RESULTS
  Thirty patients and 58 related discharges were enrolled into our study, which consisted of 13 males and 17 females, with a mean age 58.3 years. Of that total, 27 of them (90%) had amyotrophic lateral sclerosis, and four (13.3%) had comorbid cancers; 17 died during hospice care. Acute low respiratory conditions (31.0%) accounted for the most common acute comorbidity. Noninvasive ventilation care was performed in only 13 (22.4%) of the discharges. In contrast to nasogastric intubation (40 discharges, 69.0%), no gastrostomy/jejunostomy was noted. These procedures bore no relationship to results observed in the discharges. Family physicians provided most inpatient hospice services (74.1%). Respiratory problems were the major causes of death (70.6% of decedents). The mean inpatient costs of hospice care were noticeably reduced from previously established nationwide mean costs.
  
  
  CONCLUSIONS
  Hospice care can save costs for patients with terminal MNDs, and family physicians play a valuable role in caring for these patients. However, respiratory and feeding problems are prevalent, yet there are proven benefits when noninvasive ventilation care and gastrostomy/jejunostomy are promoted.
authors.affiliation: Division of Family Medicine, National Yang-Ming University Hospital, Yilan, Taiwan, ROC.
authors.forename: Shih-Chao
authors.initials: SC
authors.lastname: Kang
authors.forename: Shinn-Jang
authors.initials: SJ
authors.lastname: Hwang
authors.forename: Pin-Yuan
authors.initials: PY
authors.lastname: Wu
authors.forename: Ching-Piao
authors.initials: CP
authors.lastname: Tsai
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D005260:Female; D017051:Hospice Care / Q000706:statistics & numerical data*; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged; D016472:Motor Neuron Disease / Q000628:therapy*; D010821:Physicians, Family; D012121:Respiration, Artificial; D013624:Taiwan; D013997:Time Factors