title: Days spent in acute care hospitals at the end of life of cancer patients in four Swiss cantons: a retrospective database study (SAKK 89/09).
abstract: Number of days spent in acute hospitals (DAH) at the end of life is regarded as an important care quality indicator for cancer patients. We analysed DAH during 90 days prior to death in patients from four Swiss cantons. Claims data from an insurance provider with about 20% market share and patient record review identified 2086 patients as dying of cancer. We calculated total DAH per patient. Multivariable generalised linear modelling served to evaluate potential explanatory variables. Mean DAH was 26 days. In the multivariable model, using complementary and alternative medicine (DAH = 33.9; +8.8 days compared to non-users) and canton of residence (for patient receiving anti-cancer therapy, Zürich DAH = 22.8 versus Basel DAH = 31.4; for other patients, Valais DAH = 22.7 versus Ticino DAH = 33.7) had the strongest influence. Age at death and days spent in other institutions were additional significant predictors. DAH during the last 90 days of life of cancer patients from four Swiss cantons is high compared to most other countries. Several factors influence DAH. Resulting differences are likely to have financial impact, as DAH is a major cost driver for end-of-life care. Whether they are supply- or demand-driven and whether patients would prefer fewer days in hospital remains to be established.
authors: Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland.|Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland.
authors: K W
authors: KW
authors: Matter-Walstra
authors: (Formerly) Helsana Group, Dübendorf, Switzerland.
authors: R
authors: R
authors: Achermann
authors: (Formerly) Helsana Group, Dübendorf, Switzerland.
authors: R
authors: R
authors: Rapold
authors: Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland.
authors: D
authors: D
authors: Klingbiel
authors: Cancer Registry Ticino, Instituto cantonale di patologia, Locarno, Switzerland.
authors: A
authors: A
authors: Bordoni
authors: Cancer Registry Zürich and Zug, University Hospital Zürich, Zürich, Switzerland.
authors: S
authors: S
authors: Dehler
authors: Cancer Registry Valais, Observatoire valaisan de la santé, Sion, Switzerland.
authors: I
authors: I
authors: Konzelmann
authors: Cancer Registry Basel, Gesundheitsdienste Projekte & Service, Basel, Switzerland.
authors: M
authors: M
authors: Mousavi
authors: Institute for Social and Preventative Medicine (ISPM), University of Bern, Bern, Switzerland.
authors: K M
authors: KM
authors: Clough-Gorr
authors: Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland.|(Formerly) Helsana Group, Dübendorf, Switzerland.
authors: T
authors: T
authors: Szucs
authors: Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland.
authors: M
authors: M
authors: Schwenkglenks
authors: Department Oncology, University Hospital Zürich, Zürich, Switzerland.
authors: B C
authors: BC
authors: Pestalozzi
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D009369:Neoplasms / Q000628:therapy*; D012189:Retrospective Studies; D013557:Switzerland; D013727:Terminal Care / Q000706:statistics & numerical data*
keywords: cancer; complementary medicine; end of life; health services research; hospitalisation; length of stay