Variation in out‐of‐hospital death among palliative care inpatients across public hospitals in New South Wales, Australia

Abstract

BACKGROUND: Place of death is an important indicator in palliative care, as out-of-hospital death is often preferred by patients and is less costly for the healthcare system. AIM: To examine variation and contributing factors in out-of-hospital death after receiving palliative care in hospital to inform improvement in transition of care between hospitals and communities. METHODS: Using hospital linked data (July 2010, June 2015) we followed individuals aged 50 or older who received palliative care in hospital and within 3 months to death who were last admitted to a public acute-care hospital in New South Wales, Australia (73 hospitals). RESULTS: Among 25 359 palliative care inpatients, 3677 (14%) died out of hospital. The out-of-hospital death rate was lower for younger patients, males and those living in the most deprived areas; it was higher for cancer patients and those who received palliative care before their last admission. Hospital size, location and availability of hospice care unit were not influential. Across hospitals, the median crude rate of out-of-hospital death was 14% (interquartile range 10-19%). The contributing factors explained 19% of the variation, resulting in a rate difference of 44% between hospitals with high versus low rates; 25% of hospitals had a higher and 14% had a lower than average adjusted out-of-hospital death rate. CONCLUSION: The majority of patients who received palliative care in hospital stayed in hospital until death. The variation in out-of-hospital death across hospitals was considerable and mostly remained unexplained. This variability warrants investigation into transition of palliative care between hospitals and communities to inform interventions.