title: Hospice care in the Netherlands: who applies and who is admitted to inpatient care?
abstract: BACKGROUND
  Ten percent of non-sudden deaths in the Netherlands occur in inpatient hospice facilities. To investigate differences between patients who are admitted to inpatient hospice care or not following application, how diagnoses compare to the national population, characteristics of application, and associations with being admitted to inpatient hospice care or not.
  
  
  METHODS
  Data from a database representing over 25% of inpatient hospice facilities in the Netherlands were analysed. The study period spanned the years 2007-2012. Multivariate regression analyses were performed to study associations between demographic and application characteristics, and admittance.
  
  
  RESULTS
  Ten thousand two hundred fifty-four patients were included. 84.1% of patients applying for inpatient hospice care had cancer compared to 37.0% of deaths nationally. 52.4% of applicants resided in hospital at the time of admission. Most frequent reasons for application were the wish to die in an inpatient hospice facility (70.5%), needing intensive care or support (52.2 ), relieving caregivers (41.4%) and needing pain/symptom control (39.9%). Living alone (OR 1.68, 95% CI 1.46-1.94), having cancer (OR 1.40, 95% CI 1.11-1.76), relieving caregivers (OR 1.18, 95% CI 1.01-1.38), needing pain/symptom control (OR1.72, 95% CI 1.46-2.03) wanting inpatient hospice care until death (vs respite care) (OR 3.59, 95% CI 2.11-6.10), wanting to be admitted as soon as possible (OR 1.64, 95% CI 1.42-1.88), and being referred by a primary care professional (OR 1.36, 95% CI 1.17-1.59) were positively associated with being admitted. Wishing to die in an inpatient hospice facility was negatively associated with being admitted (OR 0.85, 95% CI 0.72-1.00).
  
  
  CONCLUSIONS
  This study suggests that when applying for inpatient hospice care, patients who seem most urgently in need of inpatient hospice care are more frequently admitted. However, non-cancer patients seem to be an under-represented population. Staff should consider application based on need for palliation, irrespective of diagnosis.
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research - Expertise Centre for Palliative Care, VU University medical center, Amsterdam, The Netherlands. eol@vumc.nl.
authors.forename: Emily
authors.initials: E
authors.lastname: West
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research - Expertise Centre for Palliative Care, VU University medical center, Amsterdam, The Netherlands.
authors.forename: H Roeline
authors.initials: HR
authors.lastname: Pasman
authors.affiliation: Department of Registry & Research, Comprehensive Cancer Centre the Netherlands (IKNL), PO Box 19079, 3501 DB, Utrecht, The Netherlands.
authors.forename: Cilia
authors.initials: C
authors.lastname: Galesloot
authors.affiliation: Department of Registry & Research, Comprehensive Cancer Centre the Netherlands (IKNL), PO Box 19079, 3501 DB, Utrecht, The Netherlands.
authors.forename: Martine Elizabeth
authors.initials: ME
authors.lastname: Lokker
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research - Expertise Centre for Palliative Care, VU University medical center, Amsterdam, The Netherlands.
authors.forename: Bregje
authors.initials: B
authors.lastname: Onwuteaka-Philipsen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D017028:Caregivers / Q000523:psychology; D005260:Female; D017051:Hospice Care / Q000706:statistics & numerical data*; D006738:Hospices / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000523:psychology / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy; D009426:Netherlands; D010166:Palliative Care / Q000523:psychology / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D012017:Referral and Consultation; D012144:Respite Care / Q000706:statistics & numerical data
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