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Background: Rural and remote patients have reduced access to palliative care, often resulting in inter-hospital transfers and death a long way from home and family. Katherine Hospital (KH), a 50-bed hospital services a population with high Aboriginality who experience this issue.

Aims: To characterise trends in mortality and transfers at a remote hospital in reference to increasing capacity to provide palliative care.

Methods: Retrospective analysis of deaths in patients over 18 years of age, admitted between 2008 and 2018 at KH, Northern Territory. Outcome measures include number of deaths, aeromedical transfers to tertiary facility, palliative care episodes, demographics including Aboriginality, admission data and comorbidity. Statistical analysis included unpaired t-test, chi-square test and regression analysis.

Results: The number of deaths in KH increased from 23 (0.88% of inpatient admissions) in 2011 to 52 in 2018 (1.7%). During the same period, the proportion of all deaths classified as palliative increased from 51.4 to 66.0% (P = 0.001), with fewer deaths occurring in the emergency department (17.2-1.4% for the last 3 years, R = 0.75, P = 0.008). The number of aeromedical transfers of patients from KH to tertiary centres decreased from 769 (10.4% of all admissions) in 2011 to 434 (3.4%) in 2018 (P = 0.006).

Conclusions: Increasing the capacity of a remote hospital to provide palliative care allowed more patients to die closer to home and decreased inappropriate aeromedical retrievals. An increased in-hospital mortality rate should not be misinterpreted as reflecting suboptimal care if palliative intent, patients' wishes and non-clinical risk factors have not been ascertained.

Titel:	Providing palliative care closer to home: a retrospective analysis from a remote Australian hospital.
Autor/in / Beteiligte Person:	Watson, BJ ; Budd, R ; Waran, E ; Scott, I ; Quilty, S
Link:	Zum Volltext
Zeitschrift:	Internal medicine journal, Jg. 50 (2020), Heft 1, S. 48-53
Veröffentlichung:	Carlton, Vic. : Blackwell Science Asia, c2001-, 2020
Medientyp:	academicJournal
ISSN:	1445-5994 (electronic)
DOI:	10.1111/imj.14666
Schlagwort:	Aged Aged, 80 and over Australia Emergency Service, Hospital statistics & numerical data Female Hospital Mortality Hospitalization statistics & numerical data Humans Male Middle Aged Regression Analysis Retrospective Studies Rural Population Tertiary Care Centers Health Services Accessibility Health Services, Indigenous statistics & numerical data Palliative Care statistics & numerical data Rural Health Services statistics & numerical data Terminal Care
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article Language: English [Intern Med J] 2020 Jan; Vol. 50 (1), pp. 48-53. MeSH Terms: Health Services Accessibility* ; Terminal Care* ; Health Services, Indigenous / statistics & numerical data ; Palliative Care / statistics & numerical data ; Rural Health Services / *statistics & numerical data ; Aged ; Aged, 80 and over ; Australia ; Emergency Service, Hospital / statistics & numerical data ; Female ; Hospital Mortality ; Hospitalization / statistics & numerical data ; Humans ; Male ; Middle Aged ; Regression Analysis ; Retrospective Studies ; Rural Population ; Tertiary Care Centers References: McGrath P, Holewa H. End-of-life care of Aboriginal peoples in remote locations: language issues. Aust J Prim Health 2007; 13: 18-27. ; Willis J. Dying in country: implications of culture in the delivery of palliative care in Indigenous Australian communities. Anthropol Med 1999; 6: 423-35. ; Shahid S, Taylor EV, Cheetham S, Woods JA, Aoun SM, Thompson SC. Key features of palliative care service delivery to Indigenous peoples in Australia, New Zealand, Canada and the United States: a comprehensive review. BMC Palliat Care 2018; 17: 72-92. ; Australian Bureau of Statistics. Region Data Summary. Katherine Region 70205, 2011-2017 [cited 4 January 2019]. Available from URL: www.abs.gov.au. ; Quilty S, Valler D, Attia J. Rural general physicians: improving access and reducing costs of health care in the bush. Aust Health Rev 2014; 38: 420-4. ; Australian Bureau of Statistics. Region Data Summary. Katherine Region 70205, 2011-2017 [cited 4 January 2019]. Available from URL: www.abs.gov.au. ; Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373-83. ; Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P et al. Updating and validating the Charlson Comorbidity Index and score for risk adjustment in hospital discharge abstracts using data from six countries. Am J Epidemiol 2011; 10: 1093. ; The Health Roundtable. Riskman Mortality Classification System [cited 2019 April 24]. Available from URL: https://home.healthroundtable.org. ; Quilty S, Shannon G, Yao A, Sargent W, McVeigh M. Factors contributing to frequent attendance to the emergency department of a remote Northern Territory hospital. Med J Aust 2016; 204: 11. Contributed Indexing: Keywords: Aboriginal; end of life; indigenous; palliative care; remote Entry Date(s): Date Created: 20191030 Date Completed: 20201006 Latest Revision: 20201006 Update Code: 20231215

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Providing palliative care closer to home: a retrospective analysis from a remote Australian hospital.