Associations between hospital characteristics and the delivery of non-cancer palliative care: a nationwide retrospective study in Taiwan.

内容摘要

As the population ages, the need for palliative care among patients with non-cancer conditions has increased. Although the benefits of palliative care for non-cancer conditions are well established, integration of such care remains limited across many health systems. Taiwan's universal health system offers a unique opportunity to examine how hospital characteristics influence the delivery of non-cancer palliative care. We conducted a retrospective nationwide analysis of all hospitals providing palliative care through either dedicated palliative care units (PCUs) or palliative shared care (PSC) under Taiwan's National Health Insurance (2016-2020). Non-cancer patients were identified based on the absence of cancer-related diagnostic codes within the National Health Insurance (NHI) claims data. The proportion of these patients receiving palliative care per hospital year was calculated. Generalized Estimating Equations (GEE) were used to stratify the data by admission year and hospital characteristics, and to assess the associations between these hospital characteristics and the delivery of non-cancer palliative care. Values represent adjusted estimates from GEE models. Among 355 hospital-years of PCU care, the mean proportion of non-cancer patients was 18.8% and was significantly higher at the secondary-level (7.3%, p&#x2009;=&#x2009;0.019), community (13.5%, p&#x2009;=&#x2009;0.003), and rural (20.1%, p&#x2009;<&#x2009;0.001) hospitals, as well as those with more palliative care beds. In 699 hospital-years of PSC, the mean proportion of non-cancer patients was 39.7%, and it was significantly higher in hospitals without radiation oncology departments (18.1%, p&#x2009;<&#x2009;0.001) and with fewer acute care beds (p&#x2009;<&#x2009;0.05). In both models, the proportion of non-cancer patients steadily increased over time (p&#x2009;<&#x2009;0.05). Metropolitan tertiary medical centers with advanced cancer-care infrastructure have not yet accommodated a sufficient number of non-cancer patients relative to their capacity for providing palliative care. Meanwhile, rural areas as well as secondary-level and community hospitals have shown potential to deliver such care to a larger number of patients. These findings suggest that institutional size, function, and geographic location all influence access to non-cancer palliative care. They also indicate a policy implication: strengthening capacity in smaller and rural hospitals may help expand system-wide service coverage for non-cancer patients at a reasonable cost.