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Transitions between health care settings in the final three months of life in four EU countries.

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Abstract
BACKGROUND: Transitions between care settings may be related to poor quality in end-of-life care. Yet there is a lack of cross-national population-based data on transitions at the end of life. METHOD: International mortality follow-back study with data collection in Belgium, Netherlands, Italy and Spain (2009-11) via existing representative epidemiological surveillance networks of general practitioners (GPs). All general practitioners reported weekly, on a standardized registration form, every deceased patient (≥18 years) in their practice and identified those who died 'non-suddenly'. RESULTS: Among 4791 non-sudden deaths in Belgium, Netherlands, Italy and Spain, 59%, 55%, 60% and 58%, respectively, were transferred between care settings at least once in the final 3 months of life (10%, 8%, 10% and 13% in final 3 days of life); 10%, 5%, 8% and 12% were transferred three times or more (P < 0.001 in multivariate analyses adjusting for country differences in age, sex, cause of death, presence of dementia). In all countries, transitions were more frequent among patients residing at home (61-73%) than among patients residing in a care home (33-40%). Three months before death 5-7% of patients were in hospital, and this rose to 27-39% on the day of death. Patient wishes were cited as the reason for the last transition before death in 27%, 39%, 9% and 6% of cases in Belgium, Netherlands, Italy and Spain, respectively (P < 0.001). CONCLUSION: End-of-life transitions between health care settings are common across EU countries, in particular late hospitalizations for people residing at home. Frequency, type and reasons for terminal hospitalizations vary between countries.
Keywords
OLDER-PEOPLE, 6 EUROPEAN COUNTRIES, GENERAL-PRACTITIONERS, CANCER-PATIENTS, END, DEATH, PLACE, BELGIUM, NETHERLANDS, SPECIALIST PALLIATIVE CARE

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Chicago
Van den Block, Lieve, Lara Pivodic, Koen Pardon, Gé Donker, Guido Miccinesi, Sarah Moreels, Tomas Vega Alonso, Luc Deliens, and Bregje Onwuteaka-Philipsen. 2015. “Transitions Between Health Care Settings in the Final Three Months of Life in Four EU Countries.” European Journal of Public Health 25 (4): 569–575.
APA
Van den Block, Lieve, Pivodic, L., Pardon, K., Donker, G., Miccinesi, G., Moreels, S., Vega Alonso, T., et al. (2015). Transitions between health care settings in the final three months of life in four EU countries. EUROPEAN JOURNAL OF PUBLIC HEALTH, 25(4), 569–575.
Vancouver
1.
Van den Block L, Pivodic L, Pardon K, Donker G, Miccinesi G, Moreels S, et al. Transitions between health care settings in the final three months of life in four EU countries. EUROPEAN JOURNAL OF PUBLIC HEALTH. 2015;25(4):569–75.
MLA
Van den Block, Lieve, Lara Pivodic, Koen Pardon, et al. “Transitions Between Health Care Settings in the Final Three Months of Life in Four EU Countries.” EUROPEAN JOURNAL OF PUBLIC HEALTH 25.4 (2015): 569–575. Print.
@article{7036308,
  abstract     = {BACKGROUND: Transitions between care settings may be related to poor quality in end-of-life care. Yet there is a lack of cross-national population-based data on transitions at the end of life.
METHOD: International mortality follow-back study with data collection in Belgium, Netherlands, Italy and Spain (2009-11) via existing representative epidemiological surveillance networks of general practitioners (GPs). All general practitioners reported weekly, on a standardized registration form, every deceased patient (\ensuremath{\geq}18 years) in their practice and identified those who died 'non-suddenly'.
RESULTS: Among 4791 non-sudden deaths in Belgium, Netherlands, Italy and Spain, 59\%, 55\%, 60\% and 58\%, respectively, were transferred between care settings at least once in the final 3 months of life (10\%, 8\%, 10\% and 13\% in final 3 days of life); 10\%, 5\%, 8\% and 12\% were transferred three times or more (P {\textlangle} 0.001 in multivariate analyses adjusting for country differences in age, sex, cause of death, presence of dementia). In all countries, transitions were more frequent among patients residing at home (61-73\%) than among patients residing in a care home (33-40\%). Three months before death 5-7\% of patients were in hospital, and this rose to 27-39\% on the day of death. Patient wishes were cited as the reason for the last transition before death in 27\%, 39\%, 9\% and 6\% of cases in Belgium, Netherlands, Italy and Spain, respectively (P {\textlangle} 0.001).
CONCLUSION: End-of-life transitions between health care settings are common across EU countries, in particular late hospitalizations for people residing at home. Frequency, type and reasons for terminal hospitalizations vary between countries.},
  author       = {Van den Block, Lieve and Pivodic, Lara and Pardon, Koen and Donker, G{\'e} and Miccinesi, Guido and Moreels, Sarah and Vega Alonso, Tomas and Deliens, Luc and Onwuteaka-Philipsen, Bregje},
  issn         = {1101-1262},
  journal      = {EUROPEAN JOURNAL OF PUBLIC HEALTH},
  keyword      = {OLDER-PEOPLE,6 EUROPEAN COUNTRIES,GENERAL-PRACTITIONERS,CANCER-PATIENTS,END,DEATH,PLACE,BELGIUM,NETHERLANDS,SPECIALIST PALLIATIVE CARE},
  language     = {eng},
  number       = {4},
  pages        = {569--575},
  title        = {Transitions between health care settings in the final three months of life in four EU countries.},
  url          = {http://dx.doi.org/10.1093/eurpub/ckv039},
  volume       = {25},
  year         = {2015},
}

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