Characteristics of older people who experience high-cost hospital care at the end of life and report low-satisfaction: Evidence of low-value care from bereaved carer surveys in England.

BACKGROUND

A significant proportion of healthcare costs is incurred in hospitals at the end of life (EoL), with a small group of patients accounting for most of the costs. Scarce resources should be allocated based on cost-effectiveness. High costs and low satisfaction with care suggest low-value care at EoL; however, there is little evidence regarding which patients receive such care.

OBJECTIVES

To identify the characteristics of older patients who experience high-cost care but report low satisfaction with care at EoL.

DESIGN AND

METHODS

Secondary data analysis of mortality follow-back surveys: International Access, Rights, and Empowerment (IARE) studies. We surveyed the next of kin of older patients who received palliative care or died in hospital in England. Satisfaction with care at EoL and cost of hospital care calculated with quantity of services and unit costs. We used multinomial logistic regression to analyse factors associated with potentially low-value care.

RESULTS

404 patients were included (mean [SD] age: 80.4 [8.5] years). During the last three months of life, 53.8% of the total hospital care costs were incurred by 20% of the patients. 36.6% of the respondents reported low satisfaction. Compared to patients with low-cost care and reporting satisfaction, patients who were 65-74 years old (relative risk ratio [RRR] = 3.2, 95% CI: 1.09 to 9.42), had low income (RRR = 4.12, 95% CI: 1.29 to 13.15) and with an illness duration of 1-12 months (RRR = 3.93, 95% CI: 1.37 to 11.21) were more likely to receive high-cost hospital care and report low satisfaction.

CONCLUSIONS

Being younger, on low incomes and with short illness duration are associated with high-cost, low-satisfaction hospital care at EoL. Identifying underlying mechanisms may enable targeted interventions to reduce high-cost, low-value care. Further investigation is needed to change the care trajectories of patients with these risk factors.