title: Variation in hospital utilization at the end of life for patients with cancer in the Emilia-Romagna region of Italy.
abstract: BACKGROUND
  Despite the preference of many patients to die at home, high proportions of patients with advanced cancer undergo major procedures, receive intensive care, and die in the hospital. The goal of this study is to examine variation in hospital utilization and site of death for patients dying with poor-prognosis cancer in the Regione Emilia-Romagna (RER), Italy.
  
  
  METHODS
  We conducted a retrospective, population-level study using administrative data. Patients were included if they died in 2012 and had at least one hospital admission for metastatic or poor-prognosis cancer within 180 days of death. Variations in the use of the hospital, intensive care, and procedures performed were evaluated.
  
  
  RESULTS
  11,470 patients died with metastatic or poor-prognosis cancer in 2012. Seventy-eight percent of patients were hospitalized in the last month of life while 50.7% of patients died in the hospital. Results varied by local health authority from 38.3% to 69.3%. Of patients who had an ICU stay, 55.1% in the community hospitals and 59.8% in the teaching hospitals were admitted to the ICU on the day of death or the day before death. 7.5% of patients underwent a major procedure in the last 30 days of life.
  
  
  CONCLUSIONS
  The overall high rate, and substantial variation, in hospital care at the end of life offers the RER the opportunity to evaluate if increasing availability of palliative care, along with provider and patient education, could reduce utilization of high-cost hospital care and increase patient and family satisfaction.
authors: Center for Research in Medical Education and Health Care, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia - USA.
authors: Daniel Z
authors: DZ
authors: Louis
authors: Center for Research in Medical Education and Health Care, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia - USA.
authors: Sarah E
authors: SE
authors: Hegarty
authors: Agenzia Sanitaria e Sociale Regionale, Regione Emilia-Romagna, Bologna - Italy.
authors: Maurizio
authors: M
authors: Leoni
authors: Agenzia Sanitaria e Sociale Regionale, Regione Emilia-Romagna, Bologna - Italy.
authors: Rossana
authors: R
authors: De Palma
authors: Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA - USA.
authors: Stefan
authors: S
authors: Varga
authors: Department of Medical and Surgical Sciences, University of Bologna and St. Orsola-Malpighi Hospital, Bologna - Italy.
authors: Rita
authors: R
authors: Melotti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D005260:Female; D006297:Health Services Accessibility; D006760:Hospitalization; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D011159:Population Surveillance; D012189:Retrospective Studies; D013727:Terminal Care