Temporal Change in the Use of Laboratory and Imaging Tests in One Week Before Death, 2006-2015

Area of Science:

• Geriatric Medicine
• Health Services Research
• Medical Economics

Background:

• Analysis of end-of-life healthcare utilization trends in South Korea.
• Focus on laboratory and imaging test usage in the final week before death.

Purpose of the Study:

• To examine trends in laboratory and imaging test utilization among decedents aged 60 and above in Korean hospitals from 2006 to 2015.
• Investigate changes in test use per decedent over a decade.

Main Methods:

• Utilized the National Health Insurance Service-Elderly Sample Cohort (NHIS-ESC) dataset.
• Included decedents aged ≥ 60 years who died in hospitals.
• Analyzed payment claims for 28 laboratory and 6 imaging tests using Healthcare Common Procedure Coding System (HCPCS) codes.
• Employed regression analysis to assess temporal changes in test utilization.

Main Results:

• A total of 6,638 decedents were analyzed.
• Overall laboratory and imaging tests per decedent increased from 10.3 in 2006 to 16.6 in 2015.
• Laboratory test use rose annually by 7.39% (9.46 to 15.57 tests/decedent).
• Imaging test use showed a non-significant increase (0.86 to 1.01 tests/decedent).
• Test utilization increased significantly in general hospitals but not in nursing hospitals.

Conclusions:

• Laboratory and imaging test use, particularly laboratory tests, steadily increased among elderly patients nearing death.
• Reducing acute healthcare interventions at the end of life is crucial for healthcare budget sustainability.
• Optimizing end-of-life care can improve the quality of dying and death.