Hospitalisations at the end of life: a cross-national, population-based mortality followback study via nationwide representative epidemiological surveillance networks

Aims: Hospital admissions towards the end of life may indicate a low quality of dying. Yet population-based data on hospital use at the end of life are scarce. We aimed to describe and compare the frequency, length and timing of acute hospital admissions in the last three months of life in Belgium (BE), the Netherlands (NL), Italy (IT) and Spain (ES).

Method: Cross-national, population-based mortality followback study via nationwide representative epidemiological surveillance networks of general practitioners (GPs). Using a standardised form, GPs recorded the care in the last three months of life of every deceased adult practice patient (01/01/2009-31/12/2011). Nursing home deaths from the NL (6%) were excluded as they are not attended by GPs. Analysis involved descriptive statistics, chi-squared tests and multivariate logistic regression analysis.

Results: We studied 7,209 deaths. In BE, NL, IT and ES, 53%, 48%, 51% and 52% of patients, respectively (p
Conclusions: Across countries, and particularly in Belgium, hospital care in the last three months of life is highly prevalent and increases considerably in the final days of life, suggesting an institutionalised nature of dying. Differences between countries may reflect differences in healthcare policy and end-of-life care practice.