A Comparison of Healthcare Utilization between Older
Patients with and without Cancer at a University Hospital
in Thailand
Chattaris T, MD¹, Srinonprasert V, MD¹, Pitiyarn S, RN, APN¹, Suraarunsumrit P, MD¹
Affiliation : ¹ Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective: To compare the health care utilization and address the appropriate time to optimize the palliative care provided
between cancer and non-cancer older patients.
Materials and Methods: A retrospective review of patients at least 60 years old admitted and discharged alive in 2013 was investigated. The patients were selected and classified into the cancer and the non-cancer groups, according to the criteria of advanced diseases. Any health care utilization and advance care planning documentation (ACP) were collected. The deceased data of patients were retrieved from the Bureau of Registration Administration in January 2018, and the time interval to death was recorded. Comparison between both groups was performed.
Results: There were 130 cancer patients and 176 non-cancer patients. The median length of hospitalization of the non-cancer group and the cancer group was 11 and 7 days, respectively (p<0.001). The rate of performed endotracheal intubation and tracheostomy were higher in the non-cancer group (p<0.001). Moreover, in the non-cancer group, the health care costs of the last admission in 2013 were three times higher than those in the cancer group (p<0.001). Additionally, the median time interval to dead from last discharge date in 2013 until January 2018 was significantly longer in the non-cancer group, compared to the cancer group (347 (0 to 1,653) days and 81 (0 to 1,349) days, respectively, p<0.001).
Conclusion: In the non-cancer group, the health care utilization was higher. Therefore, optimally provided palliative care and ACP for the patients with advanced illnesses, especially the non-cancer patients with the suitable criteria for advanced diseases might improve quality of care and decrease the futile invasive procedures and the health care costs.
Keywords : Palliative care, Advance care planning, Cancer patients, Non-cancer patients, Advanced diseases, Health care utilization,
Health care costs, Invasive procedures
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