medical care; place of death; end-of-life; resource use; multimorbidity
Hedinger Damian, Braun Julia, Kaplan Vladimir, Bopp Matthias (2016), Determinants of aggregate length of hospital stay in the last year of life in Switzerland, in BMC Health Services Research
, 16, 463.
Hedinger Damian (2016), Gesundheitsversorgung am Lebensende - Soziale Ungleichheit in Bezug auf Institutionsaufenthalte und Sterbeorte
, Springer VS, Wiesbaden.
Hedinger Damian, Haemmig Oliver, Braun Julia, Bopp Matthias (2015), Social determinants of duration of last nursing home stay at the end of life in Switzerland: a retrospective cohort study, in BMC Geriatrics
, 15, 114.
Hedinger Damian, Zellweger Ueli, Braun Julia, Kaplan Vladimir, Bopp Matthias (2014), Moving to and dying in a nursing home depends not only on health – An analysis of socio-demographic determinants of place of death in Switzerland, in PLoS ONE
, 9(11), e113236.
Holzer Barbara, Siebenhüner Klarissa, Bopp Matthias, Minder Christoph (2014), Overcoming cut-off restrictions in multimorbidity prevalence estimates, in BMC Public Health
, 14, 780.
Zellweger Ueli, Bopp Matthias, Holzer Barbara, Kaplan Vladimir (2014), Prevalence of chronic medical conditions in Switzerland: Improving estimates validity by combining imperfect data sources, in BMC Public Health
, 14, 1157.
Bopp Matthias, Holzer Barbara (2013), Prevalence of Multimorbidity in Switzerland -Definition and Data Sources, in PRAXIS
, 101(25), 1609-1613.
Acute care hospitals and long-term care facilities have increasingly become places of death for the terminally ill; however, most people prefer to die at home. Due to progress of modern medicine many previously fatal diseases can be treated (but not cured) and are transformed to chronic medical conditions (diseases and impairments) with need for ongoing medical care. Various projections show that within 20 years 50% and more of the population may be living with multimorbidity (defined as co-occurrence of two or more chronic medical conditions in the same person). Multimorbidity is significantly associated with higher mortality, increased disability, decline of functional status, decreased quality of life, and leads to an intensive utilization of health care services. Patients with multimorbidity, especially those near their end-of-life, are a highly vulnerable population to undergo aggressive medical care, even if such care might be unwanted and inappropriate. Given the individual preference for dying at home, the growing population with multimorbidity at high risk for aggressive medical care, and the potential economic implications of institutional dying, we need a better understanding of the determinants of pathways of inpatient care (admissions to acute care hospitals and long-term care facilities) during the last years of life. Knowledge of these determinants (chronic medical conditions and their co-occurrence, socio-demographic characteristics, and information on availability of medical resources) might help to control a further upsurge of medical services provided to the terminally ill.Hitherto, in Switzerland, there are no population based data on the prevalence and duration of inpatient care in acute care hospitals and long-term care facilities during the last years of life. We will congregate these data based on anonymous record linkage using three different data sources: the Swiss Hospital Discharge Statistics (acute care hospitals), the Statistics of the Socio-medical Institutions (long-term care facilities), and the Swiss National Cohort (nationwide data-base combining individual data from the Swiss Census and the Cause of Death Registry). This linkage will enable access to a wealth of socio-demographic and medical information on a nationwide level and will allow a comprehensive analysis of medical and non-medical determinants of the place of death and the patterns of inpatient care at the end-of-life.Part A of our project will focus on medical proximity to death (selected chronic medical conditions and their multiples) and explore the impact of multimorbidity on survival and pathways of inpatient medical care. Study entry will be defined by the first hospitalization with a given multimorbid condition and follow-up will end on the day of death, or will be censored (if the day of death cannot be defined) on the last day of the most recent hospital or long-term care facility discharge.Part B of our project will assess inpatient care during the period preceding death (temporal proximity to death). We will disentangle stays in acute care hospitals and long-term care facilities and analyze determinants of pathways of inpatient care at the end-of-life. The observation period will be defined by the date of death and analyses will be retrospective over the last two years of life.In 2014, we will rebuild our database including recent data years (2009 to 2012) from the three different data sources in order to explore trends over time.This research project will provide substantial novel information on pathways of medical care (use of inpatient services and interaction of hospital and long-term care) in the last years of life, allow exploration of medical, regional and socio-demographic determinants, and help understanding the impact of specific chronic medical conditions and their combinations on survival. It will further allow estimations of lifetime prevalence of inpatient health care use due to specified multimorbid conditions and will enable to explore changes of pathways of inpatient care at the end-of-life before and after the implementation of the new Swiss reimbursement system (SwissDRG). We expect that this novel information will contribute to the international discussion on dying with dignity and to the political decision making and health policy development in Switzerland.