{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T12:48:39Z","timestamp":1765370919080,"version":"3.46.0"},"reference-count":15,"publisher":"BMJ","issue":"e1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Support Palliat Care"],"accepted":{"date-parts":[[2021,11,4]]},"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>We aimed to examine the influence of chronic diseases in emergency department (ED) and inpatient utilisation and expenditures in the 12 months before death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective cohort study of ED and inpatient database. Adults deceased at a hospital in Portugal in 2013 were included. We tested the influence of chronic diseases on the number of ED visits, hospital admissions and expenditures using generalised linear models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study included 484 patients (81.8% \u226565\u2009years, median two chronic diseases). Nearly all (91.3%) attended the ED in the 12 months before death. The median number of admissions was 1, median expenditure was \u20ac6159. Adjusting for confounders, chronic pulmonary disease increased ED and inpatient utilisation (1.49; 95%\u2009CI: 1.22 to 1.83; 95%\u2009CI 1.29, 1.09 to 1.51). Increased ED utilisation was observed for patients with renal disease, dementia and metastatic solid tumour (1.40, 95%\u2009CI 1.15 to 1.71; 1.39, 95%\u2009CI 1.11 to 1.75; 1.31, 95%\u2009CI 1.07 to 1.60). Other malignancies showed increased inpatient utilisation (1.24, 95%\u2009CI 1.09 to 1.42). The number of chronic conditions had a considerable effect on expenditures (3: 2.08, 95%\u2009CI 1.44 to 2.99; \u22654: 4.02, 95%\u2009CI 2.51 to 6.45).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We found a high use of hospitals at the end of life, particularly EDs. Our findings suggest that people with cancer, renal disease, chronic pulmonary disease and dementia are relevant when developing cost-effective alternatives to hospital care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjspcare-2021-003103","type":"journal-article","created":{"date-parts":[[2021,11,24]],"date-time":"2021-11-24T13:25:47Z","timestamp":1637760347000},"page":"e466-e469","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Emergency department and hospital utilisation and expenditures in the last year of life: retrospective chronic diseases cohort study"],"prefix":"10.1136","volume":"14","author":[{"given":"Ana","family":"Antunes","sequence":"first","affiliation":[{"name":"NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisboa, Portugal"}]},{"given":"Barbara","family":"Gomes","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal"},{"name":"Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute of Palliative Care and Rehabilitation, London, UK"}]},{"given":"Lu\u00eds","family":"Campos","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Medicina do Hospital S\u00e3o Francisco Xavier, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal"},{"name":"NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal"}]},{"given":"Miguel","family":"Coelho","sequence":"additional","affiliation":[{"name":"NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6048-396X","authenticated-orcid":false,"given":"S\u00edlvia","family":"Lopes","sequence":"additional","affiliation":[{"name":"NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal"},{"name":"Comprehensive Health Research Centre, Universidade NOVA de Lisboa, Lisboa, Portugal"}]}],"member":"239","published-online":{"date-parts":[[2021,11,24]]},"reference":[{"key":"2025121000503141000_14.e1.e466.1","doi-asserted-by":"publisher","DOI":"10.1177\/0269216318815794"},{"key":"2025121000503141000_14.e1.e466.2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-025180"},{"key":"2025121000503141000_14.e1.e466.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthplace.2014.02.002"},{"key":"2025121000503141000_14.e1.e466.4","unstructured":"Comiss\u00e3o Nacional de Cuidados Paliativos (CNCP) . Plano Estrat\u00e9gico de Desenvolvimento Cuidados Paliativos. Bi\u00e9nio 2019-2020, 2019. Available: https:\/\/www.sns.gov.pt\/wp-content\/uploads\/2019\/04\/PEDCP-2019-2020-versao-final-10.02.2019.pdf"},{"key":"2025121000503141000_14.e1.e466.5","unstructured":"Connor SR . Global atlas of palliative care, 2020. Available: http:\/\/www.thewhpca.org\/resources\/global-atlas-on-end-of-life-care"},{"key":"2025121000503141000_14.e1.e466.6","doi-asserted-by":"crossref","first-page":"e883","DOI":"10.1016\/S2214-109X(19)30172-X","article-title":"The escalating global burden of serious health-related suffering: projections to 2060 by world regions, age groups, and health conditions","volume":"7","author":"Sleeman","year":"2019","journal-title":"Lancet Glob Health"},{"key":"2025121000503141000_14.e1.e466.7","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1177\/0269216317743961","article-title":"Risk factors for hospital death in conditions needing palliative care: nationwide population-based death certificate study","volume":"32","author":"Gomes","year":"2018","journal-title":"Palliat Med"},{"key":"2025121000503141000_14.e1.e466.8","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1007\/s10433-018-0485-0","article-title":"The current and projected burden of multimorbidity: a cross-sectional study in a southern Europe population","volume":"16","author":"Laires","year":"2019","journal-title":"Eur J Ageing"},{"key":"2025121000503141000_14.e1.e466.9","unstructured":"Administra\u00e7\u00e3o Central do Sistema de Sa\u00fade IP . Contrato-Programa 2013: Metodologia para defini\u00e7\u00e3o de pre\u00e7os e fixa\u00e7\u00e3o de objetivos. Lisboa: : ACSS, 2012. Available: http:\/\/www.acss.min-saude.pt\/wp-content\/uploads\/2016\/07\/2012-11-30_Metodologia_HH_ULS_2013-1.pdf-1.pdf [Accessed 11 Jun 2020]."},{"key":"2025121000503141000_14.e1.e466.10","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000182534.19832.83"},{"key":"2025121000503141000_14.e1.e466.11","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-015-1202-8","article-title":"Acute hospital-based services used by adults during the last year of life in New South Wales, Australia: a population-based retrospective cohort study","volume":"15","author":"Goldsbury","year":"2015","journal-title":"BMC Health Serv Res"},{"key":"2025121000503141000_14.e1.e466.12","unstructured":"Berchet C . Emergency care services: trends, drivers, and interventions to manage the demand. Paris: OECD Health Working Papers No. 83. OECD, 2015."},{"key":"2025121000503141000_14.e1.e466.13","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.57.3568"},{"key":"2025121000503141000_14.e1.e466.14","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2015.1419"},{"key":"2025121000503141000_14.e1.e466.15","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1093\/eurpub\/cku221","article-title":"Comparing the performance of the Charlson\/Deyo and Elixhauser comorbidity measures across five European countries and three conditions","volume":"25 Suppl 1","author":"Gutacker","year":"2015","journal-title":"Eur J Public Health"}],"container-title":["BMJ Supportive &amp; Palliative Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjspcare-2021-003103","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T08:51:46Z","timestamp":1765356706000},"score":1,"resource":{"primary":{"URL":"https:\/\/spcare.bmj.com\/lookup\/doi\/10.1136\/bmjspcare-2021-003103"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,24]]},"references-count":15,"journal-issue":{"issue":"e1","published-online":{"date-parts":[[2024,4,30]]},"published-print":{"date-parts":[[2024,5]]}},"alternative-id":["10.1136\/bmjspcare-2021-003103"],"URL":"https:\/\/doi.org\/10.1136\/bmjspcare-2021-003103","relation":{},"ISSN":["2045-435X","2045-4368"],"issn-type":[{"type":"print","value":"2045-435X"},{"type":"electronic","value":"2045-4368"}],"subject":[],"published":{"date-parts":[[2021,11,24]]}}}