title: Hospitalisations at the end of life in four European countries: a population-based study via epidemiological surveillance networks.
abstract: BACKGROUND
  There is a paucity of cross-national population-based research on hospitalisations of people at the end of life. We aimed to compare, in four European countries, the frequency, time, length of and factors associated with hospitalisations in the last 3 months of life.
  
  
  METHODS
  Population-based mortality follow-back study via Sentinel Networks of general practitioners (GPs) in Belgium, the Netherlands, Italy and Spain. Using a standardised form, GPs recorded the care in the last 3 months of life of every deceased practice patient (≥18 years; 1 January 2009 to 31 December 2011). Sudden deaths were excluded.
  
  
  RESULTS
  We studied 4791 deaths that GPs described as non-sudden (66% of all registered deaths). Between 49% (the Netherlands) and 56% (Belgium) of patients were hospitalised at least once in the last 3 months of life. Readmissions were less frequent in the Netherlands (8%) than in the other countries (15-20%, p<0.001). Chances of being hospitalised increased over the last 10 days of life across countries but remained lowest in the Netherlands (Belgium: 21-37%, the Netherlands: 15-29%, Italy: 16-37%, Spain: 14-31%). Hospitalisations in the last week of life were more likely if patients resided at home rather than in a care home (ORs and 95% CIs Belgium: 1.94 (1.28 to 2.94); the Netherlands: 2.61 (1.10 to 6.18); Spain: 4.72 (1.64 to 13.57); non-significant in Italy) and less likely if the GP knew the patient's preferred place of death (ORs and 95% CIs Belgium: 0.52 (0.36 to 0.74); the Netherlands: 0.48 (0.25 to 0.91); Spain: 0.24 (0.13 to 0.44), non-significant in Italy).
  
  
  CONCLUSIONS
  The use of hospitals at the end-of-life increased over the last weeks of life of patients in all countries studied, but remained lowest in the Netherlands, as did the rate of readmissions. This may be due to gatekeeping by GPs who are trained and supported in preventing hospital readmissions at the end of life.
authors.affiliation: Department of Family Medicine & Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.
authors.forename: Lara
authors.initials: L
authors.lastname: Pivodic
authors.affiliation: Department of Family Medicine & Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.
authors.forename: Koen
authors.initials: K
authors.lastname: Pardon
authors.affiliation: ISPO Cancer Prevention and Research Institute, Florence, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Miccinesi
authors.affiliation: Public Health Directorate, Ministry of Health, Autonomous Community of Castile and Leon, Valladolid, Spain.
authors.forename: Tomas
authors.initials: T
authors.lastname: Vega Alonso
authors.affiliation: Scientific Institute of Public Health, Brussels, Belgium.
authors.forename: Sarah
authors.initials: S
authors.lastname: Moreels
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
authors.forename: Gé A
authors.initials: GA
authors.lastname: Donker
authors.affiliation: Health Centre Segovia Rural, Segovia, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Arrieta
authors.affiliation: Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Bregje D
authors.initials: BD
authors.lastname: Onwuteaka-Philipsen
authors.affiliation: Department of Family Medicine & Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
authors.affiliation: Department of Family Medicine & Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.
authors.forename: Lieve
authors.initials: L
authors.lastname: Van den Block
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005060:Europe / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D013727:Terminal Care; D055815:Young Adult
keywords: CHRONIC DI; Epidemiological methods; PALLIATIVE CARE; PRIMARY CARE; PUBLIC HEALTH