1. © Crown copyright Time Spent in Hospital During the Last 6 Months of Life. Geographical Variations for Persons Dying from Various Causes of Death. N. Robery, R. Mulliss, A. Pring and J. Verne Knowledge and Intelligence Team, South West INTRODUCTION METHODS A feature of good end of life care is keeping people in their preferred place of care. Home is the preferred place of death for many people and hospital the least preferred (1). Despite this, hospital remains the most common place of death, with 51% of all deaths occurring in hospital (2). Presented are geographical variations in the amount of time spent in hospital during the last 6 months of life for persons dying from various causes of death. A decrease in the amount of time spent in hospital is used as a proxy measure for effective person centred, efficient end of life care and better quality of life, with fewer unnecessary hospital admissions and more efficient discharge procedures. Hospital Episode Statistics data (2010-2012) was used to determine the total time spent in hospital during the final 6 months of life for people dying from various causes of death. This was used in combination with ONS mortality statistics (excluded from the analysis were persons without a hospital admission, those in specialist, community or mental health hospitals and people with an external underlying cause of death, not falls). Day cases were not included in the analysis. The measure accounted for 75% of the population for all causes of death, suggesting 3 out of 4 people will spend time in hospital during the last 6 months of life. Calculation of the Measure: The amount of time spent in an acute hospital in the last 6 months of life, was expressed as an average of the actual bed days divided by the number of people: Average Number of Days Spent in Hospital in Last 6 Months of Life = Actual bed days was calculated as the total bed days spent in an acute hospital in the 6 months prior to death for those people who died within a specific year. This was then divided by the number of people admitted to hospital in the last 6 months of life. Measure of Deprivation: The Income Deprivation Affecting Older People Index (IDAOPI) was used as the measure of deprivation, as the majority of the population considered were old (70% over 75 years of age) and therefore this index was a better predictor of deprivation than using other methods. RESULTS CONCLUSIONS REFERENCES The average number of days spent in hospital may help to indicate in which areas community based end of life care is most effective. These findings show that there is a smaller proportion of people dying in hospital in the South of England, which is indicative of better palliative care, irrespective of the cause of death. This is particularly noteworthy as reports show the South of England has the highest percentage of people aged over 65 (20%) (3). London have the lowest percentage of over 65s (11%) (3), but has been highlighted as being a particularly poor area for keeping people at home/in the community towards the last six months of life. The differences identified by CCG and deprivation, pinpoint particular areas where palliative care is considerably worse than others for different causes of death. In particular North Tyneside, Trafford and City and Hackney have particularly low percentages for certain causes of death. These geographical differences suggests a further area of exploration to identify why certain areas, namely the London based and more deprived areas, spend a greater proportion of the last 6 months of life in a hospital than other more affluent areas. 3 in 4 will spend time in hospital during last 6 months of life – Of these they will spend an average of 3 weeks in hospital. 1.National End of Life Care Intelligence Network (NEoLCIN), PHE, “Local preferences and place of death on regions within England 2010” 2014 2.NEoLCIN, PHE “End of Life Care CCG Profile: cause of death and place of death” 2012. Available from: http://www.endoflifecare- intelligence.org.uk/profiles/CCGs/Place_and_Cause_of_Death/atlas.htmlhttp://www.endoflifecare- intelligence.org.uk/profiles/CCGs/Place_and_Cause_of_Death/atlas.html 3.NEoLCIN, PHE “Variations in place of death in England: inequalities or appropriate consequences of age, gender and cause of death” 2012 HOW TO PREPARE YOUR POSTER: Scientific posters usually include the following information: Title and authors Introduction Methods Results Conclusions Acknowledgements References Draw a rough sketch of your planned layout first to better visualise where the components of your poster should be placed. Posters need to be readable from distances of approximately three feet (one metre) or more, so please use a body text size of 20 point or greater. Keep your text to a minimum. Your emphasis should be on graphics, charts, graphs and photos. Your poster should aim to stimulate discussion, not give a long presentation. 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Do not distort the logo in any way and do not place any text or other logos close to it. The text is all ranged left in the title bar, this is the PHE style. If you need to change the shape of the poster: Click on the top header and ungroup it. Click on the logo and press ctrl-x. Resize the poster. Press ctrl-v to paste the logo back in the correct proportions. Make sure that it is repositioned with plenty of clear space around it, for guidance see the original placement. Delete this section before sending your poster to print Table 1: Average Number of Days Spent in Hospital During the Last 6 Months of Life between the CCGs, for Alzheimer’s Dementia & Senility, England 2010-12. Clinical Commissioning Group (CCG)Commissioning Region Deprivation Quintile Average No. Days South Devon and Torbay South West311.8 Canterbury and Coastal South East414.2 Bradford Districts Yorkshire and the Humber114.5 North East Lincolnshire Yorkshire and the Humber215.6 Kernow South West315.7 North Lincolnshire Yorkshire and the Humber316.7 Castle Point and Rochford East of England416.8 Darlington Northern England317.0 South Worcestershire West Midlands417.0 East Lancashire Greater Manchester, Lancashire & South Cumbria217.1 Guildford and Waverley South East537.8 Tower Hamlets London137.8 West London (K&C & QPP) London238.0 Stockport Greater Manchester, Lancashire & South Cumbria438.0 Gateshead Northern England138.3 Hammersmith and Fulham London138.6 Waltham Forest London138.9 City and Hackney London139.8 Trafford Greater Manchester, Lancashire & South Cumbria341.6 North Tyneside Northern England269.2 Lowest Average Highest Average Alzheimer’s, dementia and senility: a difference of over a month between North Tyneside (69 days) and South Devon and Torbay (12 days) (Table 1). Cancer: a difference of two and a half weeks between City and Hackney (31 ½ days) and Thanet (14 ½ days). CHD: a difference of almost three weeks between Central Manchester (30 days) and Canterbury and Coastal (11 days). COPD: a difference of three weeks between Islington (35 ½ days) and Bracknell & Ascot (14 ½ days). Liver Disease: over a months difference between East Surrey (44 ½ days) and Isle of Wight (15 days). Stroke: a month’s difference between Corby (39 ½ days) and Bradford City (12 days). Falls: a difference of over 2 months between Bassetlaw (77 days) and South West Lincolnshire (0 days). When looking at deprivation quintiles and the different causes of death, the proportion of time spent in hospital increases with increasing levels of deprivation, consistent across all the different causes of death. On average there was a 4 day difference between the least deprived and most deprived areas in England. There was a difference of 5 days between the least and most affluent quintile for stroke, with 4 days each for cancer and COPD, compared to only a 2 day difference for liver disease. All the causes of death showed a negative relationship between deprivation and the average number of days spent in hospital during the last six months of life, indicating that those in the more deprived areas have a higher number of hospital stays compared to the more affluent areas. Figure 1: Average Number of Days Spent in Hospital During the Last 6 Months of Life between the CCGs, England 2010-12 Table 2: Spearman's Rank Correlation between the IDAOPI and Average Number of Days Spent in Hospital During the Last 6 Months of Life, England 2010-12 Cause of DeathCorrelationP-ValueR2R2 Alzheimer’s, Dementia & Senility-0.1830.0080.047 Cancer-0.430<0.0010.241 CHD-0.305<0.0010.114 COPD-0.335<0.0010.132 Falls-0.0930.1790.010 Liver-0.1170.0890.024 Stroke-0.273<0.0010.086 All Causes-0.406<0.0010.215 For Alzheimer’s, dementia and senility, cancer, CHD, COPD and stroke the relationship was statistically significant. The range in correlation strengths, suggests that income deprivation may have a more influential role for certain causes of death and not others, particularly strong for cancer. This finding is consistent with previous research, suggesting that those from more deprived areas are more likely to die in hospital when dying of cancer (4). However, as indicated by the R 2 value, there is still a lot of unexplained variance in the association (Table 2) and may suggest other factors other than deprivation may have a bearing. Map 1: Geographical Variation in the Average Number of Days Spent in Hospital During the Last 6 Months of Life, for All Causes of Death, by CCG, England 2010-12 Contains Ordnance Survey data © Crown copyright and database right 2014. Contains National Statistics data © Crown copyright and database right 2014. There was variation in the average number of days spent in hospital during the last six months of life between the different causes of death, with the lowest occurring for falls (at 15 days) and the highest for Alzheimer’s, dementia and senility (at 26 days); a difference of 11 days. An average of three weeks was spent in hospital during the last six months of life, for all causes of death. With the exception of falls, where Greater Manchester, Lancashire and South Cumbria had the highest, London showed the highest number of days spent in hospital during the last six months of life. People dying from all causes of death in London spent six days more time in hospital during the last six months of life compared with persons from the South West of England, that had the lowest. Map 1 highlights in and around London and the Northern areas as having higher hospital stays than the South of England. For all causes of death there was approximately a 15 day difference between the Clinical Commissioning Group (CCG) with the greatest number of days and the CCG with the lowest number of days. The CCG with the highest average was City and Hackney with 32 ½ days and the CCG with the lowest average was South Devon and Torbay with 15 days. The CCGs with the lowest number of days were mainly situated in London and the CCGs with the highest number of days in the South West. In particular the CCGs situated in South West and South East had fewer days spent in hospital, across all the different causes of death. The difference in the average number of days varied across the different causes of death (Figure 1):