Impact of availability of an inpatient hospice unit on the parent hospital's quality of palliative care for Taiwanese XXXX decedents, 2001-2006.

@entity5 @entity1
CONTEXT: Hospice care has increasingly been shown to affect quality of palliative care at both the individual and institutional levels. However, an institutional effect has only been addressed in single comprehensive @entity5 centers/selected community hospitals. OBJECTIVES: To investigate the impact of an inpatient hospice unit on the parent hospital's quality of palliative care. METHODS: This was a retrospective cohort study using administrative data from the entire population of 204,850 Taiwanese pediatric and adult @entity5 @entity1 who died in 2001-2006. Outcome variables were adjusted by multivariate logistic regression for five groups of confounding variables: 1) @entity1 demographics and disease characteristics, 2) primary hospital characteristics, 3) primary physician specialty, 4) health care resources at the hospital and regional levels, and 5) historical trend. RESULTS: Taiwanese @entity5 @entity1 who received primary care in a hospital with an inpatient hospice unit (whether or not they received hospice care) were significantly less likely to be intubated (adjusted odds ratio [AOR]: 0.71; 95% confidence interval [CI]: 0.58, 0.86) and use mechanical ventilation support (AOR: 0.70; 95% CI: 0.56, 0.87) in their last month of life. They also were more likely to use hospice care before death (AOR: 3.51; 95% CI: 1.57, 7.86). Furthermore, if they used hospice care, they tended to be referred earlier than @entity5 @entity1 being cared for in a hospital without an inpatient hospice unit. CONCLUSION: Integrating both acute care and palliative care approaches to caring for terminally ill @entity5 @entity1 in the same hospital may influence the quality of palliative care throughout the hospital as evidenced by our findings that these @entity1 have lower likelihood of being intubated with mechanical ventilation support in the last month of life, greater propensity to receive hospice care in the last year of life, and a trend toward earlier referral to hospice care. The generalizability of these results may be limited to @entity1 who died of a noncancer cause and by the two groups not being exactly matched for @entity1 ' characteristics.
