%0 Journal Article %J Eur.J.Public Health %D 2015 %T Transitions between health care settings in the final three months of life in four EU countries %A Van den Block,L. %A Pivodic,L. %A Pardon,K. %A G.A. Donker %A Miccinesi,G. %A S Moreels %A T. Vega Alonso %A Deliens,L. %A B.D. Onwuteaka-Philipsen %K a %K age %K ALL %K Analyses %K article %K AS %K at %K Belgium %K Brussels %K cancer %K care %K Case %K cause %K Cause of Death %K chronic %K Common %K community %K Countries %K cross-national %K data %K Data collection %K Death %K deaths %K Dementia %K differences %K electronic %K end %K end of life %K End-of-life %K EPIDEMIOLOGICAL %K EU %K families %K Family %K Frequency %K general %K GENERAL PRACTITIONER %K general practitioners %K GP %K Group %K health %K health care %K health services %K Health Services Research %K HEALTH-CARE %K Health-services %K hospital %K Hospitalization %K Institute %K International %K IS %K ITALY %K journal %K Life %K medical %K Medicine %K method %K mortality %K Multivariate %K Netherlands %K Network %K networks %K OCCUPATIONAL %K Occupational Health %K ON %K p %K Patient %K patients %K People %K population based %K population-based %K Practice %K practitioner %K Practitioners %K prevention %K public %K public health %K Public-health %K Quality %K registration %K Research %K result %K results %K Service %K Services %K sex %K Spain %K study %K Surveillance %K The Netherlands %K time %K Times %K Type %K Universities %K university %K WHO %X

BACKGROUND: Transitions between care settings may be related to poor quality in end-of-life care. Yet there is a lack of cross-national population-based data on transitions at the end of life. METHOD: International mortality follow-back study with data collection in Belgium, Netherlands, Italy and Spain (2009-11) via existing representative epidemiological surveillance networks of general practitioners (GPs). All general practitioners reported weekly, on a standardized registration form, every deceased patient (>/=18 years) in their practice and identified those who died 'non-suddenly'. RESULTS: Among 4791 non-sudden deaths in Belgium, Netherlands, Italy and Spain, 59%, 55%, 60% and 58%, respectively, were transferred between care settings at least once in the final 3 months of life (10%, 8%, 10% and 13% in final 3 days of life); 10%, 5%, 8% and 12% were transferred three times or more (P < 0.001 in multivariate analyses adjusting for country differences in age, sex, cause of death, presence of dementia). In all countries, transitions were more frequent among patients residing at home (61-73%) than among patients residing in a care home (33-40%). Three months before death 5-7% of patients were in hospital, and this rose to 27-39% on the day of death. Patient wishes were cited as the reason for the last transition before death in 27%, 39%, 9% and 6% of cases in Belgium, Netherlands, Italy and Spain, respectively (P < 0.001). CONCLUSION: End-of-life transitions between health care settings are common across EU countries, in particular late hospitalizations for people residing at home. Frequency, type and reasons for terminal hospitalizations vary between countries

%B Eur.J.Public Health %V ? %8 30/3/2015 %G eng %1 38009 %R http://dx.doi.org/10.1093/eurpub/ckv039