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Healthcare utilization at the end of life in people dying from amyotrophic lateral sclerosis : a retrospective cohort study using linked administrative data

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Abstract
Background: ALS is an incurable neurodegenerative disorder, with the recommendation that symptom management and palliative care start immediately or soon after diagnosis. However, little is known about healthcare utilization at the end of life in this patient group. Aim: To describe healthcare utilization at the end of life in patients who died from ALS. Design: We performed a retrospective cohort study using population-level administrative databases. The description of healthcare utilization was based on (1) validated quality indicators for end-of-life care, and (2) the European Federation of Neurological Societies guidelines on the clinical management of ALS. Setting: We included all people who died from ALS in Belgium between 2010 and 2015 (using ICD-10 code G12.2). Results: 1636 people died from ALS in Belgium between 2010 and 2015. The mean age at death was 71 years (SD11.3), and 56% were men. Specialized palliative care was used by 44% at some point in the last two years of life. In the last month of life, 13% received tube feeding, 48% received diagnostic testing, 41% were admitted to a hospital, and 25% were admitted to an emergency department. Medications were used mainly to treat pain (43%), insomnia and fatigue (33%) and thrombosis (32%); 39% used riluzole. Non-invasive ventilation was used by 18%. 39% died at home. Conclusion: Administrative data provide a valuable source to describe healthcare utilization in small populations such as ALS, but more clinical evidence is needed on the advantages and disadvantages initiating or terminating treatments at the end of life.
Keywords
Palliative care, Neurodegenerative diseases, Retrospective studies, Registries, OF-LIFE, PALLIATIVE CARE, NONINVASIVE VENTILATION, CANCER, DEATH, DATABASES, INDICATORS, DISEASE, PLACE

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MLA
Maetens, Arno, et al. “Healthcare Utilization at the End of Life in People Dying from Amyotrophic Lateral Sclerosis : A Retrospective Cohort Study Using Linked Administrative Data.” JOURNAL OF THE NEUROLOGICAL SCIENCES, vol. 406, 2019, doi:10.1016/j.jns.2019.116444.
APA
Maetens, A., Deliens, L., De Bleecker, J., Caraceni, A., De Ridder, M., Beernaert, K., & Cohen, J. (2019). Healthcare utilization at the end of life in people dying from amyotrophic lateral sclerosis : a retrospective cohort study using linked administrative data. JOURNAL OF THE NEUROLOGICAL SCIENCES, 406. https://doi.org/10.1016/j.jns.2019.116444
Chicago author-date
Maetens, Arno, Luc Deliens, Jan De Bleecker, Augusto Caraceni, Mark De Ridder, Kim Beernaert, and Joachim Cohen. 2019. “Healthcare Utilization at the End of Life in People Dying from Amyotrophic Lateral Sclerosis : A Retrospective Cohort Study Using Linked Administrative Data.” JOURNAL OF THE NEUROLOGICAL SCIENCES 406. https://doi.org/10.1016/j.jns.2019.116444.
Chicago author-date (all authors)
Maetens, Arno, Luc Deliens, Jan De Bleecker, Augusto Caraceni, Mark De Ridder, Kim Beernaert, and Joachim Cohen. 2019. “Healthcare Utilization at the End of Life in People Dying from Amyotrophic Lateral Sclerosis : A Retrospective Cohort Study Using Linked Administrative Data.” JOURNAL OF THE NEUROLOGICAL SCIENCES 406. doi:10.1016/j.jns.2019.116444.
Vancouver
1.
Maetens A, Deliens L, De Bleecker J, Caraceni A, De Ridder M, Beernaert K, et al. Healthcare utilization at the end of life in people dying from amyotrophic lateral sclerosis : a retrospective cohort study using linked administrative data. JOURNAL OF THE NEUROLOGICAL SCIENCES. 2019;406.
IEEE
[1]
A. Maetens et al., “Healthcare utilization at the end of life in people dying from amyotrophic lateral sclerosis : a retrospective cohort study using linked administrative data,” JOURNAL OF THE NEUROLOGICAL SCIENCES, vol. 406, 2019.
@article{8628220,
  abstract     = {Background: ALS is an incurable neurodegenerative disorder, with the recommendation that symptom management and palliative care start immediately or soon after diagnosis. However, little is known about healthcare utilization at the end of life in this patient group. 
Aim: To describe healthcare utilization at the end of life in patients who died from ALS. 
Design: We performed a retrospective cohort study using population-level administrative databases. The description of healthcare utilization was based on (1) validated quality indicators for end-of-life care, and (2) the European Federation of Neurological Societies guidelines on the clinical management of ALS. 
Setting: We included all people who died from ALS in Belgium between 2010 and 2015 (using ICD-10 code G12.2). 
Results: 1636 people died from ALS in Belgium between 2010 and 2015. The mean age at death was 71 years (SD11.3), and 56% were men. Specialized palliative care was used by 44% at some point in the last two years of life. In the last month of life, 13% received tube feeding, 48% received diagnostic testing, 41% were admitted to a hospital, and 25% were admitted to an emergency department. Medications were used mainly to treat pain (43%), insomnia and fatigue (33%) and thrombosis (32%); 39% used riluzole. Non-invasive ventilation was used by 18%. 39% died at home. 
Conclusion: Administrative data provide a valuable source to describe healthcare utilization in small populations such as ALS, but more clinical evidence is needed on the advantages and disadvantages initiating or terminating treatments at the end of life.},
  articleno    = {116444},
  author       = {Maetens, Arno and Deliens, Luc and De Bleecker, Jan and Caraceni, Augusto and De Ridder, Mark and Beernaert, Kim and Cohen, Joachim},
  issn         = {0022-510X},
  journal      = {JOURNAL OF THE NEUROLOGICAL SCIENCES},
  keywords     = {Palliative care,Neurodegenerative diseases,Retrospective studies,Registries,OF-LIFE,PALLIATIVE CARE,NONINVASIVE VENTILATION,CANCER,DEATH,DATABASES,INDICATORS,DISEASE,PLACE},
  language     = {eng},
  pages        = {6},
  title        = {Healthcare utilization at the end of life in people dying from amyotrophic lateral sclerosis : a retrospective cohort study using linked administrative data},
  url          = {http://dx.doi.org/10.1016/j.jns.2019.116444},
  volume       = {406},
  year         = {2019},
}

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