Quality of Palliative Care in Nursing Homes and Community Care in Deceased with Chronic Obstructive Pulmonary Disease (COPD), Dementia, Amyotrophic Lateral Sclerosis (ALS), and Cancer: A Retrospective Analysis of Claims Data (2016-2019).

ObjectivePalliative care is more commonly provided to patients with cancer than to those with non-oncological conditions. Little is known about the prevalence of inappropriate care and whether differences exist depending on the underlying disease. This study investigates the care during the last month of life in patients with cancer and non-oncological conditions, such as amyotrophic lateral sclerosis (ALS), chronic obstructive pulmonary disease (COPD), and dementia, considering the care setting (nursing home vs. community care).MethodsWe conducted a population-based, retrospective analysis of deceased in 2016-2019 with COPD (n = 4,036), dementia (n = 40,853), or ALS (n = 608). Logistic regression analyses compared the care quality with that of the deceased with cancer (n = 58,315). Interaction analyses examined setting effects. Outcome measures included validated quality indicators: hospital and intensive care unit (ICU) stays, emergency service utilization, and place of death.ResultsDeceased with COPD, dementia, and ALS more frequently utilized emergency services compared to those with cancer (40.4%, 28.4%, 29.0% vs. 24.4%, respectively, p < .05) and were less likely to die in a hospital (excluding palliative care units; 38.2%, 15.3%, 25.7% vs. 40.3%, respectively, p < .05). Differences were observed in ICU (13.6%, 3.4%, 6.1% vs. 4.3%, respectively, p < .05) and hospital admissions (42.7% for COPD vs. 31.5% for oncological patients, p < .001). The same pattern was observed across all conditions: deceased in community care had higher rates in all quality indicators than those in nursing homes.ConclusionsThe results suggest differences in care quality depending on the underlying disease. Nononcological patients in community care are less frequently and less adequately cared for than oncological patients.