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Hospital admissions at the end of life: reasons, appropriateness and avoidability (FLIECE).

Author: Thijs Reyniers

Date: 03-06-2015

Author: Thijs Reyniers

Promotor: Prof. dr. Dirk Houttekiers and Prof. dr. Luc Deliens
Co-Promotors: Prof. dr. Joachim Cohen and Prof. dr. Robert Vander Stichele

Summary of the dissertation

Background
The acute hospital setting consistently remains a frequent place of death in most high-income countries; in Belgium nearly half of all deaths occur in the hospital setting. To reduce the number of hospital deaths there has been an increased interest in reducing the number of end-of-life hospital admissions. The present dissertation aims to shed some light on the complexity of the reasons for and circumstances leading to such admissions and to provide a more thorough understanding about the appropriateness and avoidability of these admissions.

Methods
In a first part, the proportion of older persons with a dementia-related disease who die in hospital in Belgium is examined, using death certificate data. In a second part family physicians’ perspectives are explored concerning their role in preventing and guiding end-of-life hospital admissions and the difficulties they experience, using a focus group methodology. In a third part, the reasons, appropriateness and avoidability of end-of-life hospital admissions are explored, using a mixed method approach: focus groups among family physicians and nurses from different care settings (home care, care home and hospital); interviews with family carers whose relative had died in hospital; and surveys among family physicians whose patients had died non-suddenly in the acute hospital setting of a university hospital.

Results
Although the acute hospital setting is considered not to be an ideal setting for end-of-life care or as a place of death, most terminal hospital admissions might be considered appropriate or unavoidable, either due to a medical complication (e.g. pneumonia), the patients’ preferences or because of an inadequate care setting. Further implications for policy and practice that could reduce the number of end-of-life hospital admissions are provided in this dissertation.

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