The Use of Life-Sustaining Treatments for Patients in Their Final Month Before Death

• Main Authors: Wei-Ting Hsu, 許瑋庭
• Other Authors: Tzuo-Yun Lan
• Format: Others
• Language: zh-TW
• Published: 2015
• Online Access: http://ndltd.ncl.edu.tw/handle/27327040971540710831

碩士 === 國立陽明大學 === 醫務管理研究所 === 103 === Background With the rapid development of medical technology, human life as measured by life expectancy is steadily increasing. However, part of the extended life can be attributable to the use of life-sustaining treatment. Life supported by these treatments sometimes comes with pain and poor quality of life to the patients and their families. More importantly, they will spend a lot on end of life.Life-sustaining treatment is usually used in the end stage of life, accounting for one-third of the lifetime medical use. Objective The purpose of this study was to investigate the use of life-sustaining treatment and to estimate medical utilization for people during their final month before death. This study further investigated the use of different combinations of life-sustaining treatment for the users. Study Design This descriptive study retrospectively used 2007 to 2012 claims data from the National Health Insurance Research Database. The original sample was two million people randomly drawn from the total population in 2005. The study sample included 49,068 deaths between 2008 and 2011. Life-sustaining treatment was defined as the use of mechanical ventilation, cardiopulmonary resuscitation, vasopressor, intraaortic balloon pumping, extra-corporeal membrane oxygenation and hemodialysis for patients at the critical conditions. According to their use of life-sustaining treatment in the final month before death. Study sample was divided into the use or no use groups. Besides, the use group was further divided into several subgroups based on the use of different life-sustaining treatment. The no use group was further divided into medical subgroup and no medical use subgroup. This study will use SAS 9.4 to descript the study population about medical utilization in the final month before death. Results In the study sample, there were 53.58% people who had used life-sustaining treatment, 27.67% people who did not use life-sustaining treatment had medical use, and 18.76% people who both did not use life-sustaining treatment and had no medical use. About 90% of the use group also used ICU service. In the no use group about 76% of medical use subgroup used hospice. The use group had higher lenth of stay, lenth of stay in ICU, and medical costs than the no use group. Vasopressor was often used in the group who had used life-sustaining treatment. In the subgroups of the use of different life-sustaining treatment, 25% used only one, 36% had two, 35% had three, and 4% need four life-sustaing treatments. Furthermore, the use of four life-sustaining treatment had higher lenth of stay in ICU and medical costs. Conclusion In Taiwan, there are about 50% usage of life-sustaining treatment for patients in the final month before death. We suggest that further research is needed to better examine the futile treatment potentially existing in the life-sustaining treatments.