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Background: There is clear evidence that the full range of services required to support people dying at home are far from being implemented, either in England or elsewhere. No studies to date have attempted to identify the proportion of hospital admissions that could have been avoided amongst patients with palliative care needs, given existing and current local services. This study aimed to examine the extent of potentially avoidable admissions amongst hospital patients with palliative care needs. Methods: A cross sectional survey of palliative care needs was undertaken in two acute hospitals in England. Appropriateness of admission was assessed by two Palliative Medicine Consultants using the following data collected from case notes: reasons for admission; diagnosis and co-morbidities; age and living arrangements; time and route of admission; medical and nursing plan on admission; specialist palliative care involvement; and evidence of cognitive impairment. Results: A total of 1359 inpatients were present in the two hospitals at the time of the census. Of the 654 consenting patients/consultees, complete case note data were collected for 580 patients; the analysis in this paper relates to these 580 patients. Amongst 208 patients meeting diagnostic and prognostic criteria for palliative care need in two acute settings in England, only 6.7% were identified as 'potentially avoidable' hospitalisations. These patients had a median age of 84. Half of the patients lived in residential or nursing homes and it was concluded that most could have received care in this setting in place of hospital. Conclusion: Our findings challenge assumptions that, within the existing configuration of palliative and end of life health and social care services, patients with palliative care needs experience a high level of potentially avoidable hospitalisations. [ABSTRACT FROM AUTHOR]

Background The need to more fully understand the economics of palliative care provision is widely acknowledged; however, the evidence base regarding the extent of potentially avoidable admissions in the last year of life, and the link between reducing/redistributing overall costs of end-of-life care has not been previously evaluated. Aim A narrative review of the evidence relating to the potential economic impact of reducing avoidable admissions among palliative care patients in the UK. Methods Ten electronic bases were searched in 2010 using key terms to identify UK literature relating to the economic consequence of avoidable hospital admissions among palliative care patients. Results Five studies met the inclusion criteria. Two were randomized controlled trials comparing the addition of new services to support patients in the community at the end of life with the existing standard service provided; one was a descriptive analysis of the change in usage and costs of health care services following the introduction of two community-based services; two were retrospective analyses of patient records for patient who had died in hospital to estimate the proportion of final admissions that could be classified as avoidable. Conclusions The evidence base from the UK relating to the economic impact of avoidable admissions in palliative care is limited. Although two recent retrospective studies suggest that there are currently high levels of avoidable admissions, the feasibility of avoiding such admissions and the full economic consequences of such changes have not been clearly demonstrated. Further evidence is needed to provide a more robust estimate of the extent to which the additional costs of providing high-quality community support are offset by reduced inpatient usage by palliative care patients. Prospective studies are needed which seek to demonstrate the scale of admissions which can actually be avoided in clinical practice, when issues such as capacity constraints come into play. [ABSTRACT FROM AUTHOR]