No Cover Image

Journal article 126 views 30 downloads

Health and care service utilisation in the last year of life before non-sudden death in Wales, 2014–2023, by palliative care registration: a population-based retrospective cohort study

Rhiannon Owen Orcid Logo, Rowena Bailey, Helen Daniels Orcid Logo, Athena McBride, Ashley Akbari Orcid Logo, Elinor Curnow, Alison Cooper, Natalie Joseph-Williams, Adrian Edwards, Maria Parry, Idris Baker Orcid Logo

The Lancet Regional Health - Europe, Volume: 59, Start page: 101479

Swansea University Authors: Rhiannon Owen Orcid Logo, Rowena Bailey, Helen Daniels Orcid Logo, Athena McBride, Ashley Akbari Orcid Logo

  • 69390.VOR.pdf

    PDF | Version of Record

    © 2025 The Authors. This is an open access article distributed under the terms of the Creative Commons CC-BY license.

    Download (1.39MB)

Check full text

DOI (Published version): 10.1016/j.lanepe.2025.101479

Abstract

Background: End-of-life health and care service provision are complex processes. We aimed to quantify the uptake of health and care services in the last year of life before death from non-sudden causes by palliative care registration. Methods: Population-scale linked administrative and health data i...

Full description

Published in: The Lancet Regional Health - Europe
ISSN: 2666-7762
Published: Elsevier BV 2025
Online Access: Check full text

URI: https://cronfa.swan.ac.uk/Record/cronfa69390
first_indexed 2025-05-01T16:01:43Z
last_indexed 2025-11-07T05:02:49Z
id cronfa69390
recordtype SURis
fullrecord <?xml version="1.0"?><rfc1807><datestamp>2025-11-05T12:26:49.0916541</datestamp><bib-version>v2</bib-version><id>69390</id><entry>2025-05-01</entry><title>Health and care service utilisation in the last year of life before non-sudden death in Wales, 2014&#x2013;2023, by palliative care registration: a population-based retrospective cohort study</title><swanseaauthors><author><sid>0d30aa00eef6528f763a1e1589f703ec</sid><ORCID>0000-0001-5977-376X</ORCID><firstname>Rhiannon</firstname><surname>Owen</surname><name>Rhiannon Owen</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>455e2c1e6193448f6269b9e72acaf865</sid><firstname>Rowena</firstname><surname>Bailey</surname><name>Rowena Bailey</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>a054902cb884be2476d0f097f0016294</sid><ORCID>0000-0001-8899-0333</ORCID><firstname>Helen</firstname><surname>Daniels</surname><name>Helen Daniels</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>4def66cb410a07fa9606d2ebd54e46f4</sid><firstname>Athena</firstname><surname>McBride</surname><name>Athena McBride</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>aa1b025ec0243f708bb5eb0a93d6fb52</sid><ORCID>0000-0003-0814-0801</ORCID><firstname>Ashley</firstname><surname>Akbari</surname><name>Ashley Akbari</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2025-05-01</date><deptcode>MEDS</deptcode><abstract>Background: End-of-life health and care service provision are complex processes. We aimed to quantify the uptake of health and care services in the last year of life before death from non-sudden causes by palliative care registration. Methods: Population-scale linked administrative and health data in the last year of life for Welsh residents who died of non-sudden causes were modelled using multi-state models between 2014 and 2023. Cox regression were used to estimate hazards for transitions between care settings, including people's homes, care homes with and without nursing, emergency, elective and other hospital admissions, and death. The primary outcome was rate of transition reported as hazard ratios (HR) with corresponding 95% confidence intervals (95% CI) adjusted for age, sex, rurality, area-level deprivation, and palliative care registration. Secondary outcomes included expected length of stay (ELOS). Findings: Our analyses included 267,199 individuals, with 1,845,572 transitions. There were 74,045 (27.7%) individuals registered for palliative care, under-represented groups included men, most-deprived and living alone. Most time was spent at home, with 370,752 (90.3%) of 410,441 emergency admissions from home. There was a 23% (HR 1.23 [95% CI 1.22&#x2013;1.25]) increased transition rate of emergency admissions from home for palliative care registered compared with unregistered individuals, with a decreased expected length of stay (ELOS 25.34 [95% CI 25.34&#x2013;25.34] vs 26.87 [26.87&#x2013;26.87]). Emergency admissions from care homes with and without nursing were 17% (HR 0.83 [95% CI 0.80&#x2013;0.86]) and 18% (HR 0.82 [95% CI 0.79&#x2013;0.85]) lower for palliative care registered compared with unregistered individuals, with an increased rate of discharge from emergency hospital settings (HR 2.00 [95% CI 1.92&#x2013;2.09] and 1.62 [1.54&#x2013;1.69]). Interpretation: Palliative care status was associated with health and care utilisation at the end-of-life. Efficient identification of individuals needing palliative care and additional support at home should be prioritised for system optimisation.</abstract><type>Journal Article</type><journal>The Lancet Regional Health - Europe</journal><volume>59</volume><journalNumber/><paginationStart>101479</paginationStart><paginationEnd/><publisher>Elsevier BV</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>2666-7762</issnElectronic><keywords>Palliative care; End of life; Healthcare utilisation; Care home; Electronic health records; Routine data; Administrative data</keywords><publishedDay>1</publishedDay><publishedMonth>12</publishedMonth><publishedYear>2025</publishedYear><publishedDate>2025-12-01</publishedDate><doi>10.1016/j.lanepe.2025.101479</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm>Other</apcterm><funders>This work was supported by the Health and Care Research Wales (HCRW) Evidence Centre, which is funded by the Welsh Government. RKO is supported by a Health and Care Research Wales - NIHR Advanced Fellowship (HCRW NIHR FS(A)-2023b-RO/NIHR303628) and HCRW Senior Research Leaders Award (SRL-25-019). Elinor Curnow works in the Medical Research Council Integrative Epidemiology Unit at the University of Bristol which is supported by the UK Medical Research Council (grant no MC_UU_00032/02) and the University of Bristol.</funders><projectreference/><lastEdited>2025-11-05T12:26:49.0916541</lastEdited><Created>2025-05-01T10:32:47.6538386</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Rhiannon</firstname><surname>Owen</surname><orcid>0000-0001-5977-376X</orcid><order>1</order></author><author><firstname>Rowena</firstname><surname>Bailey</surname><order>2</order></author><author><firstname>Helen</firstname><surname>Daniels</surname><orcid>0000-0001-8899-0333</orcid><order>3</order></author><author><firstname>Athena</firstname><surname>McBride</surname><order>4</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>5</order></author><author><firstname>Elinor</firstname><surname>Curnow</surname><order>6</order></author><author><firstname>Alison</firstname><surname>Cooper</surname><order>7</order></author><author><firstname>Natalie</firstname><surname>Joseph-Williams</surname><order>8</order></author><author><firstname>Adrian</firstname><surname>Edwards</surname><order>9</order></author><author><firstname>Maria</firstname><surname>Parry</surname><order>10</order></author><author><firstname>Idris</firstname><surname>Baker</surname><orcid>0000-0002-9957-237x</orcid><order>11</order></author></authors><documents><document><filename>69390__35557__0c7115564a9845cf9ef8829ad7a0d291.pdf</filename><originalFilename>69390.VOR.pdf</originalFilename><uploaded>2025-11-05T12:18:52.4446339</uploaded><type>Output</type><contentLength>1452814</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; 2025 The Authors. This is an open access article distributed under the terms of the Creative Commons CC-BY license.</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>http://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling 2025-11-05T12:26:49.0916541 v2 69390 2025-05-01 Health and care service utilisation in the last year of life before non-sudden death in Wales, 2014–2023, by palliative care registration: a population-based retrospective cohort study 0d30aa00eef6528f763a1e1589f703ec 0000-0001-5977-376X Rhiannon Owen Rhiannon Owen true false 455e2c1e6193448f6269b9e72acaf865 Rowena Bailey Rowena Bailey true false a054902cb884be2476d0f097f0016294 0000-0001-8899-0333 Helen Daniels Helen Daniels true false 4def66cb410a07fa9606d2ebd54e46f4 Athena McBride Athena McBride true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 2025-05-01 MEDS Background: End-of-life health and care service provision are complex processes. We aimed to quantify the uptake of health and care services in the last year of life before death from non-sudden causes by palliative care registration. Methods: Population-scale linked administrative and health data in the last year of life for Welsh residents who died of non-sudden causes were modelled using multi-state models between 2014 and 2023. Cox regression were used to estimate hazards for transitions between care settings, including people's homes, care homes with and without nursing, emergency, elective and other hospital admissions, and death. The primary outcome was rate of transition reported as hazard ratios (HR) with corresponding 95% confidence intervals (95% CI) adjusted for age, sex, rurality, area-level deprivation, and palliative care registration. Secondary outcomes included expected length of stay (ELOS). Findings: Our analyses included 267,199 individuals, with 1,845,572 transitions. There were 74,045 (27.7%) individuals registered for palliative care, under-represented groups included men, most-deprived and living alone. Most time was spent at home, with 370,752 (90.3%) of 410,441 emergency admissions from home. There was a 23% (HR 1.23 [95% CI 1.22–1.25]) increased transition rate of emergency admissions from home for palliative care registered compared with unregistered individuals, with a decreased expected length of stay (ELOS 25.34 [95% CI 25.34–25.34] vs 26.87 [26.87–26.87]). Emergency admissions from care homes with and without nursing were 17% (HR 0.83 [95% CI 0.80–0.86]) and 18% (HR 0.82 [95% CI 0.79–0.85]) lower for palliative care registered compared with unregistered individuals, with an increased rate of discharge from emergency hospital settings (HR 2.00 [95% CI 1.92–2.09] and 1.62 [1.54–1.69]). Interpretation: Palliative care status was associated with health and care utilisation at the end-of-life. Efficient identification of individuals needing palliative care and additional support at home should be prioritised for system optimisation. Journal Article The Lancet Regional Health - Europe 59 101479 Elsevier BV 2666-7762 Palliative care; End of life; Healthcare utilisation; Care home; Electronic health records; Routine data; Administrative data 1 12 2025 2025-12-01 10.1016/j.lanepe.2025.101479 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Other This work was supported by the Health and Care Research Wales (HCRW) Evidence Centre, which is funded by the Welsh Government. RKO is supported by a Health and Care Research Wales - NIHR Advanced Fellowship (HCRW NIHR FS(A)-2023b-RO/NIHR303628) and HCRW Senior Research Leaders Award (SRL-25-019). Elinor Curnow works in the Medical Research Council Integrative Epidemiology Unit at the University of Bristol which is supported by the UK Medical Research Council (grant no MC_UU_00032/02) and the University of Bristol. 2025-11-05T12:26:49.0916541 2025-05-01T10:32:47.6538386 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Rhiannon Owen 0000-0001-5977-376X 1 Rowena Bailey 2 Helen Daniels 0000-0001-8899-0333 3 Athena McBride 4 Ashley Akbari 0000-0003-0814-0801 5 Elinor Curnow 6 Alison Cooper 7 Natalie Joseph-Williams 8 Adrian Edwards 9 Maria Parry 10 Idris Baker 0000-0002-9957-237x 11 69390__35557__0c7115564a9845cf9ef8829ad7a0d291.pdf 69390.VOR.pdf 2025-11-05T12:18:52.4446339 Output 1452814 application/pdf Version of Record true © 2025 The Authors. This is an open access article distributed under the terms of the Creative Commons CC-BY license. true eng http://creativecommons.org/licenses/by/4.0/
title Health and care service utilisation in the last year of life before non-sudden death in Wales, 2014–2023, by palliative care registration: a population-based retrospective cohort study
spellingShingle Health and care service utilisation in the last year of life before non-sudden death in Wales, 2014–2023, by palliative care registration: a population-based retrospective cohort study
Rhiannon Owen
Rowena Bailey
Helen Daniels
Athena McBride
Ashley Akbari
title_short Health and care service utilisation in the last year of life before non-sudden death in Wales, 2014–2023, by palliative care registration: a population-based retrospective cohort study
title_full Health and care service utilisation in the last year of life before non-sudden death in Wales, 2014–2023, by palliative care registration: a population-based retrospective cohort study
title_fullStr Health and care service utilisation in the last year of life before non-sudden death in Wales, 2014–2023, by palliative care registration: a population-based retrospective cohort study
title_full_unstemmed Health and care service utilisation in the last year of life before non-sudden death in Wales, 2014–2023, by palliative care registration: a population-based retrospective cohort study
title_sort Health and care service utilisation in the last year of life before non-sudden death in Wales, 2014–2023, by palliative care registration: a population-based retrospective cohort study
author_id_str_mv 0d30aa00eef6528f763a1e1589f703ec
455e2c1e6193448f6269b9e72acaf865
a054902cb884be2476d0f097f0016294
4def66cb410a07fa9606d2ebd54e46f4
aa1b025ec0243f708bb5eb0a93d6fb52
author_id_fullname_str_mv 0d30aa00eef6528f763a1e1589f703ec_***_Rhiannon Owen
455e2c1e6193448f6269b9e72acaf865_***_Rowena Bailey
a054902cb884be2476d0f097f0016294_***_Helen Daniels
4def66cb410a07fa9606d2ebd54e46f4_***_Athena McBride
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
author Rhiannon Owen
Rowena Bailey
Helen Daniels
Athena McBride
Ashley Akbari
author2 Rhiannon Owen
Rowena Bailey
Helen Daniels
Athena McBride
Ashley Akbari
Elinor Curnow
Alison Cooper
Natalie Joseph-Williams
Adrian Edwards
Maria Parry
Idris Baker
format Journal article
container_title The Lancet Regional Health - Europe
container_volume 59
container_start_page 101479
publishDate 2025
institution Swansea University
issn 2666-7762
doi_str_mv 10.1016/j.lanepe.2025.101479
publisher Elsevier BV
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description Background: End-of-life health and care service provision are complex processes. We aimed to quantify the uptake of health and care services in the last year of life before death from non-sudden causes by palliative care registration. Methods: Population-scale linked administrative and health data in the last year of life for Welsh residents who died of non-sudden causes were modelled using multi-state models between 2014 and 2023. Cox regression were used to estimate hazards for transitions between care settings, including people's homes, care homes with and without nursing, emergency, elective and other hospital admissions, and death. The primary outcome was rate of transition reported as hazard ratios (HR) with corresponding 95% confidence intervals (95% CI) adjusted for age, sex, rurality, area-level deprivation, and palliative care registration. Secondary outcomes included expected length of stay (ELOS). Findings: Our analyses included 267,199 individuals, with 1,845,572 transitions. There were 74,045 (27.7%) individuals registered for palliative care, under-represented groups included men, most-deprived and living alone. Most time was spent at home, with 370,752 (90.3%) of 410,441 emergency admissions from home. There was a 23% (HR 1.23 [95% CI 1.22–1.25]) increased transition rate of emergency admissions from home for palliative care registered compared with unregistered individuals, with a decreased expected length of stay (ELOS 25.34 [95% CI 25.34–25.34] vs 26.87 [26.87–26.87]). Emergency admissions from care homes with and without nursing were 17% (HR 0.83 [95% CI 0.80–0.86]) and 18% (HR 0.82 [95% CI 0.79–0.85]) lower for palliative care registered compared with unregistered individuals, with an increased rate of discharge from emergency hospital settings (HR 2.00 [95% CI 1.92–2.09] and 1.62 [1.54–1.69]). Interpretation: Palliative care status was associated with health and care utilisation at the end-of-life. Efficient identification of individuals needing palliative care and additional support at home should be prioritised for system optimisation.
published_date 2025-12-01T07:38:13Z
_version_ 1850743658731536384
score 11.088929

Similar Items