Utilization of hospice and nonhospice care in patients with end-stage renal disease on dialysis

Shu-Chen Wang; Kai-Chieh Hu; Wei-Chuan Chang; Chung-Y Hsu

doi:10.4103/tcmj.tcmj_207_21

Utilization of hospice and nonhospice care in patients with end-stage renal disease on dialysis

Tzu Chi Med J. 2021 Dec 9;34(2):232-238. doi: 10.4103/tcmj.tcmj_207_21. eCollection 2022 Apr-Jun.

Authors

Shu-Chen Wang^{1

2}, Kai-Chieh Hu³, Wei-Chuan Chang⁴, Chung-Y Hsu^{5

6}

Affiliations

¹ Department of Nursing, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
² Department of Nursing, Tzu Chi University, Hualien, Taiwan.
³ Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
⁴ Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
⁵ College of Medicine, China Medical University, Taichung, Taiwan.
⁶ Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.

Abstract

Objectives: The prevalence of end-stage renal disease (ESRD) and the number of patients undergoing dialysis in Taiwan are high. Since September 2009, the National Health Insurance has started to provide hospice care to patients with renal failure in Taiwan. Therefore, it is necessary to understand the use of hospice and nonhospice care in patients with ESRD on dialysis. We aim to understand trends in patients with ESRD receiving hospice and nonhospice care as well as medical care efforts during the last month of their lives (2009-2013).

Materials and methods: The cohort study was conducted using 1 million randomly selected samples from the Taiwan Health Insurance Research Database for millions of people in Taiwan in 2009-2013. Descriptive statistics were presented to summarize the characteristics of data. To compare differences between cohorts, Chi-square tests and Student's t-tests were used. Mann-Whitney U-tests were performed for nonnormally distributed data. Mantel-Haenszel test was test for trend.

Results: We recruited 770 ESRD patients who underwent hemodialysis; among them, 154 patients received hospice care. Patients who received hospice care had a significantly longer survival time after removal of mechanical ventilator (20 vs. 0 days) and after discontinuation of dialysis (2 vs. 0 days) compared with those who did not receive hospice care. Patients who received hospice care had more pain control (61.04% vs. 17.37%, P < 0.0001) and other symptomatic control (55.84% vs. 43.18% with diuretics, P < 0.05; 64.29% and 48.21% with laxatives, P = 0.0004) medications than those who did not. Nevertheless, the overall medical cost in the hospice group was significantly lower (90 USD and 280 USD, P < 0.0001).

Conclusion: Our results suggest that the addition of hospice care may permit patients a longer life-support-free survival time. In addition, despite a more frequent symptomatic controlling agent use, hospice care significantly reduced the overall medical expenditure.

Keywords: Dialysis; End-stage renal disease; Hospice.