Close to 50% increase in end-of-life care hospitalisations

A new Australian Institute of Health and Welfare (AIHW) report, released on 15 September, found almost one in 140 (0.7%) of all hospitalisations (11.3 million) in 2017–18 were palliative care-related.
 
That is a total of 79,932, 57% of which were for palliative care and 43% for other end-of-life care.
 
By using time series data from the National Hospital Morbidity Database to compare 2013–14 to 2017–18, the analysis has been able to for the first time separate palliative care hospitalisations and other end-of-life care hospitalisations, the latter being where care was not necessarily delivered by a palliative care specialist.
 
Over the three year period, there was a 16.9% increase in palliative care hospitalisations from about 39,000 to almost 45,600, and a 48.2% increase in other end-of-life care hospitalisations from about 23,200 to almost 34,400. Across the board, a 16% increase in hospitalisations was noted for all reasons over the same period.
 
People aged 75 and over accounted for 52.5% of palliative care hospitalisations and 53.7% of other end-of-life care. One in 10 (10.1%) were aged under 55 for palliative care, with similar findings for end-of-life care.
 
Cancer (54.6%) was the most frequent principal diagnosis for patients hospitalised for palliative care, followed by cerebrovascular disease (4.1%) and heart failure and complications (3.1%).
 
Similarly, cancer (33.8%) was the most frequent principal diagnosis for other end-of-life care, followed by influenza and pneumonia (4.9%), and septicaemia (4.8%).
 
Six in 10 palliative care hospitalisations ended with the patient’s death (61.9%), compared with four in 10 (41.2%) for other end-of-life care.

Meanwhile, the proportion of patients admitted to hospital that go on to become a palliative care patient that ended with their death has steadily increased from 32.1% to 35.8%, and from 11.9% to 18% for other end-of-life care.
 
While the report did not give a definitive reason for the increase, it did note that the growth and ageing of Australia’s population, and the corresponding increase in the prevalence of chronic, progressive and generally incurable illnesses ‘has broadened the type of patient groups requiring palliative care’.
 
Queensland had the highest rate of palliative care hospitalisations in all hospitals (23.1 per 10,000 population) and Victoria had the lowest (13).
 
Similar to previous years’ findings, the majority of palliative care (85.9%) and other end-of-life care (84.4%) hospitalisations were recorded from public hospitals.
 
The average length of stay was 9.6 days for palliative care, and 10.7 days for other end-of-life care, compared to 2.7 days for all other hospitalisations. However, the average stay was longer in private hospitals at 12.9 days, with the exception of cases in Victoria.
 
The main funding source for palliative care in public hospitals was public patient funding (76%), followed by private health insurance (20%), with similar results for other end-of-life care. In private hospitals, 57.8% was funded by private health insurance and 28.3% by public patient funding.
 
Aboriginal and Torres Strait Islander people accounted for 1113 palliative care and 682 other end-of-life care hospitalisations, with the majority occurring in public hospitals (93.6% and 99.3%, respectively).
 
As a result of Aboriginal and Torres Strait Islander people being disadvantaged across a range of health-related and socioeconomic indicators in relation to non-Indigenous Australians, the report noted that this ‘may affect their use of, and access to, admitted patient palliative care and other end-of-life care’.
 
Across both public and private sectors, the proportion of palliative care hospitalisations increased for patients whose usual residence was in major cities (63%) and decreased as remoteness increased.
 
Despite this, the rate of public hospital hospitalisations for palliative care was lowest in major cities (13.6 per 10,000) and remote and very remote areas (13.7), and highest for inner regional (21.5) and outer regional areas (23.7). The rate for other end-of-life care was similar across all remoteness areas.
 
A total of 133 out of 673 public acute hospitals nationally had a specialist palliative care inpatient unit, with 26.4% in major cities, 17.3% in regional areas and 19.1% in remote areas.
 
Only 24 of the 300 private acute and psychiatric hospitals had specialist palliative care inpatient units recorded.
 
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AIHW end-of-life care palliative care