Complexity in palliative care inpatients: prevalence and relationship with provision of care, a retrospective study

Abstract

Context: Palliative car aims to provide comprehensive care, since end of life can be marked by somatic, psycho-social and spiritual distress, requiring interdisciplinary care. However, interdiscoplinary care is costly, and palliative care services, as all other medical services, get under pressure to be as cost-effective as possible. Objectives To describe the case complexity of palliative care inpatients, to evaluate possible correlations between complexity and provision of care and to identifycomplexity subgroups. Methods Patients (N = 222) hospitalized in a specialized palliative care unit (Switzerland) were assessed regarding their biopsychosocial case complexity by means of the INTERMED. Based on a chart review, INTERMED scores were determined at admission and the end of hospitalization/death. Descriptive statistics and Pearson correlation coefficients were estimated for the association between biopsychosocial case complexity and amount and type of care provided. A principal component analysis (PCA) was conducted to explain variance and to identify patient subgroups. Results Almost all patients (98.7 %) qualified as complex as indicated by the INTERMED. Provision of care correlated positively (r=0.23, p=0.0008) with the INTERMED scores upon admission. The change of INTERMED score during stay correlated negatively with provided care (r=-0.27, p=0.0001). PCA performed with two factors explained 49% of the total variance and identified two subgroups which differed regarding the psychosocial item scores of the INTERMED. Conclusion Specialized palliative care inpatients show the highest complexity score of all populations assessed up to now with the INTERMED. Correlations between biopsychosocial complexity and care provided, and between care and decrease of complexity scores, can be considered as an indicator for care efficiency. Patient subgroups with specific needs (psychosocial burden) suggest that palliative care teams need specialized staff. Trial registration The study was accepted August 24, 2023 by the ethics committee of the Canton of Vaud (CER-VD 2023-01200).