Health care use and cost trajectories of people in the last year of life : improving planning and resource allocation in end of life care

Date of Approval: 
2018-04-30 00:00:00
Lay Summary: 
Every year more than half a million people die in the UK and the number of deaths per year is growing. The care we receive towards the end-of-life (EoL) can be very good, but sometimes it is neither the care we need nor the care we would choose. EoL care is complex, expensive and will become difficult to finance in the NHS. In addition, EoL care needs can be very different in different patient groups. These differences can be explained by clinical factors such as the type of disease but are also impacted by patient preferences. This project aims to describe health care resource use and costs of patients who are in their last year of life. Its main objective is to inform a more efficient allocation of available resources in the provision of EoL care that meets patients' needs.
Technical Summary: 
The aim of this study is to obtain a better understanding of the healthcare utilisation and health status trajectories in the last year of life and how this can be used to identify patient groups that are most likely to benefit from timely palliative care. We will first describe health status, resource use, and costs of patients in their last year of life using routinely collected linked data in a representative sample of the English population. The analysis will also aim to identify groups of patients with similar patterns of health care use and needs. This will be done using cluster analysis and latent class regression models, where each cluster/class will reflect similar trajectories of resource use or cost. The study will also seek to measure specific markers of care intensity (e.g. A&E admissions, days in ICU), appropriateness of care at the end of life, and transition probabilities between care settings. Finally, we will combine evidence from these descriptive analyses into a policy model aimed at measuring the potential efficiency gains from greater reliance on evidence-based end-of-life care.
Health Outcomes to be Measured: 
Health care resource use in the last 12 months of life (primary) - Health care costs in the last 12 months of life - Intensity of care at the end of life - Appropriateness of care at the end of life
Application Number: 
18_049
Collaborators: 

Joachim Marti - Chief Investigator - Imperial College London
Joachim Marti - Corresponding Applicant - Imperial College London
Ara Darzi - Collaborator - Imperial College London
Elias Mossialos - Collaborator - Imperial College London
Martina Orlovic - Collaborator - Imperial College London

Linkages: 
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation