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Hospitalisations at the end of life in four European countries: a population-based study via epidemiological surveillance networks
  1. Lara Pivodic1,
  2. Koen Pardon1,
  3. Guido Miccinesi2,
  4. Tomas Vega Alonso3,
  5. Sarah Moreels4,
  6. Gé A Donker5,
  7. Enrique Arrieta6,
  8. Bregje D Onwuteaka-Philipsen7,
  9. Luc Deliens1,8,
  10. Lieve Van den Block1
  1. 1Department of Family Medicine & Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
  2. 2ISPO Cancer Prevention and Research Institute, Florence, Italy
  3. 3Public Health Directorate, Ministry of Health, Autonomous Community of Castile and Leon, Valladolid, Spain
  4. 4Scientific Institute of Public Health, Brussels, Belgium
  5. 5NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
  6. 6Health Centre Segovia Rural, Segovia, Spain
  7. 7Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
  8. 8Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
  1. Correspondence to Lara Pivodic, Department of Family Medicine & Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan 103, Brussels 1090, Belgium; lara.pivodic{at}


Background There is a paucity of cross-national population-based research on hospitalisations of people at the end of life. We aimed to compare, in four European countries, the frequency, time, length of and factors associated with hospitalisations in the last 3 months of life.

Methods Population-based mortality follow-back study via Sentinel Networks of general practitioners (GPs) in Belgium, the Netherlands, Italy and Spain. Using a standardised form, GPs recorded the care in the last 3 months of life of every deceased practice patient (≥18 years; 1 January 2009 to 31 December 2011). Sudden deaths were excluded.

Results We studied 4791 deaths that GPs described as non-sudden (66% of all registered deaths). Between 49% (the Netherlands) and 56% (Belgium) of patients were hospitalised at least once in the last 3 months of life. Readmissions were less frequent in the Netherlands (8%) than in the other countries (15–20%, p<0.001). Chances of being hospitalised increased over the last 10 days of life across countries but remained lowest in the Netherlands (Belgium: 21–37%, the Netherlands: 15–29%, Italy: 16–37%, Spain: 14–31%). Hospitalisations in the last week of life were more likely if patients resided at home rather than in a care home (ORs and 95% CIs Belgium: 1.94 (1.28 to 2.94); the Netherlands: 2.61 (1.10 to 6.18); Spain: 4.72 (1.64 to 13.57); non-significant in Italy) and less likely if the GP knew the patient's preferred place of death (ORs and 95% CIs Belgium: 0.52 (0.36 to 0.74); the Netherlands: 0.48 (0.25 to 0.91); Spain: 0.24 (0.13 to 0.44), non-significant in Italy).

Conclusions The use of hospitals at the end-of-life increased over the last weeks of life of patients in all countries studied, but remained lowest in the Netherlands, as did the rate of readmissions. This may be due to gatekeeping by GPs who are trained and supported in preventing hospital readmissions at the end of life.

  • Epidemiological methods

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