The impact of the duration of the palliative care period on cancer patients with regard to the use of hospital services and the place of death : a retrospective cohort study

Background In order to avoid unnecessary use of hospital services at the end-of-life, palliative care should be initiated early enough in order to have sufficient time to initiate and carry out good quality advance care planning (ACP). This single center study assesses the impact of the PC decision and its timing on the use of hospital services at EOL and the place of death. Methods A randomly chosen cohort of 992 cancer patients treated in a tertiary hospital between Jan 2013 -Dec 2014, who were deceased by the end of 2014, were selected from the total number of 2737 identified from the hospital database. The PC decision (the decision to terminate life-prolonging anticancer treatments and focus on symptom centered palliative care) and use of PC unit services were studied in relation to emergency department (ED) visits, hospital inpatient days and place of death. Results A PC decision was defined for 82% of the patients and 37% visited a PC unit. The earlier the PC decision was made, the more often patients had an appointment at the PC unit (> 180 days prior to death 72% and <14 days 10%). The number of ED visits and inpatient days were highest for patients with no PC decision and lowest for patients with both a PC decision and an PC unit appointment (60 days before death ED visits 1.3 vs 0.8 and inpatient days 9.9 vs 2.9 respectively, p <0.01). Patients with no PC decision died more often in secondary/tertiary hospitals (28% vs. 19% with a PC decision, and 6% with a decision and an appointment to a PC unit). Conclusions The PC decision to initiate a palliative goal for the treatment had a distinct impact on the use of hospital services at the EOL. Contact with a PC unit further increased the likelihood of EOL care at primary care.Peer reviewe

Lapsilähtöinen budjetointi

Tässä selvityksessä analysoitiin valtion vuoden 2020 budjetti sekä kolmen pilottikunnan vuoden 2018 tuloslaskelmat lapsibudjetoinnin menetelmin. Analyysilla vastattiin kysymykseen siitä, mikä osuus valtionhallinnon ja pilottikuntien määrärahoista kohdistuu lapsiin ja lapsiperheisiin. Selvityksessä rakennettiin lapsibudjetoinnin viitekehys edesauttamaan lapsibudjetoinnin käyttöönottoa osana valtiontalouden budjettiprosessia sekä kuntien talousjohtamista. Lisäksi selvityksessä tuotettiin kuntien ja kuntayhtymien käyttöön malli lapsibudjetoinnin verkkotyökalusta. Lapsibudjetointi tuottaa tietoa siitä, mikä osuus julkisista varoista käytetään lapsiin, ovatko nämä resurssit linjassa suhteessa lasten hyvinvoinnille asetettuihin tavoitteisiin ja mitkä ovat kohdistettujen resurssien ja niiden jakoperiaatteiden vaikutukset lasten hyvinvointiin ja oikeuksiin. Lapsibudjetointi on ennen kaikkea palveluiden järjestäjän tiedolla johtamisen väline, joka auttaa hahmottamaan julkisin varoin kustannettua palveluverkkoa ilman eri palvelukokonaisuuksien välisiä raja-aitoja. Lapsibudjetoinnin avulla eri palveluille kohdistettuja kustannuksia voidaan tarkastella ja seurata läpinäkyvästi, mikä auttaa mahdollisimman kustannusvaikuttavia julkisia lasten ja perheiden palveluita. Lapsibudjetoinnin toteuttaminen vaatii ennen kaikkea kansallista ohjeistusta ja poliittista tahtoa. Tältä osin sen kytkeminen osaksi kansallista valmisteilla olevaa lapsistrategiaa olisi luontevaa.Tämä julkaisu on toteutettu osana valtioneuvoston selvitys- ja tutkimussuunnitelman toimeenpanoa. (tietokayttoon.fi) Julkaisun sisällöstä vastaavat tiedon tuottajat, eikä tekstisisältö välttämättä edusta valtioneuvoston näkemystä

The impact of the duration of the palliative care period on cancer patients with regard to the use of hospital services and the place of death: a retrospective cohort study

Background: In order to avoid unnecessary use of hospital services at the end-of-life, palliative care should be initiated early enough in order to have sufficient time to initiate and carry out good quality advance care planning (ACP). This single center study assesses the impact of the PC decision and its timing on the use of hospital services at EOL and the place of death. Methods: A randomly chosen cohort of 992 cancer patients treated in a tertiary hospital between Jan 2013 -Dec 2014, who were deceased by the end of 2014, were selected from the total number of 2737 identified from the hospital database. The PC decision (the decision to terminate life-prolonging anticancer treatments and focus on symptom centered palliative care) and use of PC unit services were studied in relation to emergency department (ED) visits, hospital inpatient days and place of death. Results: A PC decision was defined for 82% of the patients and 37% visited a PC unit. The earlier the PC decision was made, the more often patients had an appointment at the PC unit (> 180 days prior to death 72% and Conclusions: The PC decision to initiate a palliative goal for the treatment had a distinct impact on the use of hospital services at the EOL. Contact with a PC unit further increased the likelihood of EOL care at primary care.</div

Oral Health Outcome Measures: A Feasibility Evaluation

Objectives: Outcomes of oral health care must be measured and analysed to improve oral health care delivery, outcomes, and quality. This study aims to develop and test outcome measures for the needs of oral health organisers and explore their feasibility using clinical data. Methods: Based on the literature review and oral health advisory board, outcome measures for oral health care were identified, developed, and tested. Data from 425,000 clinical examinations were obtained from the clinical records of 8 public oral care providers in Finland. Results: The advisory board selected 7 outcome measures: 1 on oral self-care, 2 on periodontitis, 3 on caries, and 1 on missing teeth. A large variation was found in the diagnostic and data entry practices of these outcome measures. The coverage of caries and missing teeth entries was good, but the quality of initial and remineralised caries entries was questionable. The caries and missing teeth measures show statistically significant differences amongst some providers. Conclusions: The measures “new cavitated caries surfaces,” “cavity-free clinical examinations,” and “the change in the missing value” were evaluated as feasible. The results of these measures provided insight about the effectiveness of oral care and enabled the comparison between the providers and age groups. Statistically significant differences between the providers in the measures imply potential possibilities for providers to learn from each other