title: Emergency visits among end-of-life cancer patients in Taiwan: a nationwide population-based study.
abstract: BACKGROUND
  An increased number of emergency visits at the end of life may indicate poor-quality cancer care. The study aimed to investigate the prevalence and utilization of emergency visits and to explore the reasons for emergency department (ED) visits among cancer patients at the end of life.
  
  
  METHODS
  A retrospective cohort study was performed by tracking one year of ambulatory medical service records before death. Data were collected from the cancer dataset of Taiwan's National Health Insurance Research Database (NHIRD).
  
  
  RESULTS
  A total of 32,772 (19.2%) patients with malignant cancer visited EDs, and 23,883 patients died during the study period. Of these, the prevalence of emergency visits in the mortality group was 81.5%, and their ED utilization was significantly increased monthly to the end of life. The most frequent types of cancer were digestive and peritoneum cancers (34.8%), followed by breast cancer (17.7%) and head and neck cancers (13.3%). Older patients, males, and those diagnosed with metastases, respiratory or digestive cancer were more likely to use ED services at the end of life. Use of an ED service in the nearest community hospital to replace medical centers for dying cancer patients would be more acceptable in emergency situations.
  
  
  CONCLUSIONS
  Our study provided population-based evidence related to ED utilization. An understanding of the reasons for such visits could be useful in preventing overuse of ED visits to improve the quality of end-of-life care.
authors.affiliation: School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan. yhlee@mail.cgu.edu.tw.|Department of Nursing, School of Nursing, College of Medicine, Chang-Gang University, Taoyuan, Taiwan. yhlee@mail.cgu.edu.tw.
authors.forename: Yi-Hui
authors.initials: YH
authors.lastname: Lee
authors.affiliation: Institute of Public Health, College of Medicine, National Yang-Ming University, Taipei, Taiwan. dad57@tpech.gov.tw.|Department of Neurosurgery, Taipei City Hospital, Taipei, Taiwan. dad57@tpech.gov.tw.
authors.forename: Dachen
authors.initials: D
authors.lastname: Chu
authors.affiliation: Institute of Public Health, College of Medicine, National Yang-Ming University, Taipei, Taiwan. yang.nanping@gmail.com.|Department of Medical Research, Keelung General Hospital, Ministry of Health & Welfare, Keelung, Taiwan. yang.nanping@gmail.com.
authors.forename: Nan-Ping
authors.initials: NP
authors.lastname: Yang
authors.affiliation: Department of Information Management, Yuan-Ze University, Taoyuan, Taiwan. clchan@saturn.yzu.edu.tw.
authors.forename: Chien-Lung
authors.initials: CL
authors.lastname: Chan
authors.affiliation: Institute of Public Health, College of Medicine, National Yang-Ming University, Taipei, Taiwan. cspcij@mail.tygh.gov.tw.|Department of Rehabilitation, Taoyuan General Hospital, Ministry of Health & Welfare, Taoyuan, Taiwan. cspcij@mail.tygh.gov.tw.
authors.forename: Shun-Ping
authors.initials: SP
authors.lastname: Cheng
authors.affiliation: Institute of Public Health, College of Medicine, National Yang-Ming University, Taipei, Taiwan. jihtungpai@gmail.com.|Department of Oncology & Internal Medicine, Taoyuan General Hospital, Ministry of Health & Welfare, Taoyuan, Taiwan. jihtungpai@gmail.com.
authors.forename: Jih-Tung
authors.initials: JT
authors.lastname: Pai
authors.affiliation: School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan. ntchang@ntu.edu.tw.
authors.forename: Nien-Tzu
authors.initials: NT
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality* / Q000473:pathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013624:Taiwan / Q000453:epidemiology