Hospital, local palliative care network and public health: how do they involve terminally ill patients?

Background: Over one quarter of the health care expenditures is estimated to be spent for patients in the last year of life (LYL). For these patients, palliative care (PC) has been suggested as a response for improving the standards of care and reducing health costs. The aim of this study was to analyze a cohort of LYL people, in terms of comparing hospitalised patients who had been referred for PC to patients receiving usual care (UC). Methods: Retrospective study carried out on patients resident in Lecco (Italy) who died between 2012 and 2013. Records of patients were obtained from the Death certificate registry and cross-linked with Regional Healthcare Information System, Hospital Discharge Records and Palliative Care Registry. A total of 5830 patients were analyzed. Results: At least one hospitalization was reported by 2586 (44.3%) patients in the last month of life and 3957 (67.9%) patients in the last year of life. A total of 1114 (19.1%) patients were referred to palliative care with median duration of enrollment of 31 days (IQR = 11–69). PC was found to decrease the risk of hospital admission (adj-OR = 0.21; 95% CI = 0.18–0.26) and dying in hospital (adj-OR = 0.03; 95% CI = 0.02–0.04). Conclusions: Patients in the last year of life show a high risk of hospitalization, which represents a substantial component of health-care costs. Our study suggests that home PC consultation could represent an important public health strategy in order to lower hospital costs for LYL patients and reduce the probability of dying in hospital.