Healthcare utilization at the end of life in people dying from amyotrophic lateral sclerosis: A retrospective cohort study using linked administrative data.

Date: 
14-09-2019

Authors: Arno Maetens, Luc Deliens, Jan De Bleecker, Augusto Caraceni, Mark De Ridder, Kim Beernaert, Joachim Cohen

Source: 
Journal of the neurological sciences (2019)
Links: 
PubMed

Background

ALS is an incurable neurodegenerative disorder, with the recommendation that symptom management and palliative care start immediately or soon after diagnosis. However, little is known about healthcare utilization at the end of life in this patient group.

Aim

To describe healthcare utilization at the end of life in patients who died from ALS.

Design

We performed a retrospective cohort study using population-level administrative databases. The description of healthcare utilization was based on (1) validated quality indicators for end-of-life care, and (2) the European Federation of Neurological Societies guidelines on the clinical management of ALS.

Setting

We included all people who died from ALS in Belgium between 2010 and 2015 (using ICD-10 code G12.2).

Results

1636 people died from ALS in Belgium between 2010 and 2015. The mean age at death was 71 years (SD11.3), and 56% were men. Specialized palliative care was used by 44% at some point in the last two years of life. In the last month of life, 13% received tube feeding, 48% received diagnostic testing, 41% were admitted to a hospital, and 25% were admitted to an emergency department. Medications were used mainly to treat pain (43%), insomnia and fatigue (33%) and thrombosis (32%); 39% used riluzole. Non-invasive ventilation was used by 18%. 39% died at home.

Conclusion

Administrative data provide a valuable source to describe healthcare utilization in small populations such as ALS, but more clinical evidence is needed on the advantages and disadvantages initiating or terminating treatments at the end of life.

 
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