A narrative literature review of the evidence regarding the economic impact of avoidable hospitalizations amongst palliative care patients in the UK

摘要

Background: The need to more fully understand the economics of palliative care provision is widelynacknowledged; however, the evidence base regarding the extent of potentially avoidable admissions innthe last year of life, and the link between reducing/redistributing overall costs of end-of-life care has notnbeen previously evaluated.nAim: A narrative review of the evidence relating to the potential economic impact of reducing avoidablenadmissions among palliative care patients in the UK.nMethods: Ten electronic bases were searched in 2010 using key terms to identify UK literature relating to theneconomic consequence of avoidable hospital admissions among palliative care patients.nResults: Five studies met the inclusion criteria. Two were randomized controlled trials comparing the additionnof new services to support patients in the community at the end of life with the existing standard servicenprovided; one was a descriptive analysis of the change in usage and costs of health care servicesnfollowing the introduction of two community-based services; two were retrospective analyses of patientnrecords for patient who had died in hospital to estimate the proportion of final admissions that could benclassified as avoidable.nConclusions: The evidence base from the UK relating to the economic impact of avoidable admissions innpalliative care is limited. Although two recent retrospective studies suggest that there are currently highnlevels of avoidable admissions, the feasibility of avoiding such admissions and the full economicnconsequences of such changes have not been clearly demonstrated. Further evidence is needed tonprovide a more robust estimate of the extent to which the additional costs of providing high-qualityncommunity support are offset by reduced inpatient usage by palliative care patients. Prospective studiesnare needed which seek to demonstrate the scale of admissions which can actually be avoided in clinicalnpractice, when issues such as capacity constraints come into play.