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Background <p>Adults who died from stroke frequently experience recurrent hospitalisation in their final year of life, yet population-level evidence characterising documented inpatient specialist palliative care and its variation across analytically derived stroke-related diagnostic groups remains limited. This study describes patterns of hospital admissions and documented inpatient specialist palliative care in the final year of life among patients who died from stroke and examines variation across stroke-related diagnostic groups.</p> Methods <p>Retrospective, population-based data linkage study using routinely collected administrative health data from Queensland, Australia, 2009–2019. Adults whose certified underlying cause of death was stroke (ICD-10-AM I60–I64) with at least one hospital admission in the final 12 months of life were included (<i>n</i> = 13,065). Descriptive analyses were conducted; differences across stroke-related diagnostic groups and by palliative care status were assessed using chi-square tests for categorical variables and Mann–Whitney U tests for continuous variables. Reporting followed STROBE guidelines.</p> Results <p>Inpatient specialist palliative care was documented for 3,266 patients (25.0%); of these, 96.7% had their first episode recorded within the final seven days of life. Documentation rates differed markedly across stroke-related diagnostic groups (<i>p</i> &lt; 0.001), ranging from 37.6% in the ischaemic stroke group to 12.5% in the residual unspecified stroke group. Patients with documented inpatient specialist palliative care had higher comorbidity burden (CCI ≥ 3: 38.9% vs. 26.1%) and greater stroke-related hospital contact (88.2% vs. 62.0%). More than one quarter (27.5%) had no cerebrovascular diagnosis code recorded across any diagnosis field across hospital admissions in the final year of life despite stroke being their certified cause of death.</p> Conclusions <p>Among patients who died from stroke with hospital exposure in the final year of life, documented inpatient specialist palliative care was recorded for one in four and was concentrated in the terminal phase. The proportion of patients without hospital-recorded cerebrovascular codes suggests that stroke-specific diagnostic coding alone may not be sufficient to identify palliative care need across this population. Recurrent hospital admissions represent contact points for assessing palliative care needs. Prospective research is needed to determine for whom, and under what clinical circumstances, inpatient specialist palliative care integration improves care for patients with stroke.</p>

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Documented inpatient specialist palliative care and hospital admission patterns in the final year of life among people who died from stroke: a population-based data linkage study

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  • 发表日期：

    2026年7月31日

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  • Natalie Govind,
  • Gursharan K Singh,
  • Caleb Ferguson,
  • Jane L Phillips,
  • Alison P Bowers,
  • Louise D Hickman

摘要

Background

Adults who died from stroke frequently experience recurrent hospitalisation in their final year of life, yet population-level evidence characterising documented inpatient specialist palliative care and its variation across analytically derived stroke-related diagnostic groups remains limited. This study describes patterns of hospital admissions and documented inpatient specialist palliative care in the final year of life among patients who died from stroke and examines variation across stroke-related diagnostic groups.

Methods

Retrospective, population-based data linkage study using routinely collected administrative health data from Queensland, Australia, 2009–2019. Adults whose certified underlying cause of death was stroke (ICD-10-AM I60–I64) with at least one hospital admission in the final 12 months of life were included (n = 13,065). Descriptive analyses were conducted; differences across stroke-related diagnostic groups and by palliative care status were assessed using chi-square tests for categorical variables and Mann–Whitney U tests for continuous variables. Reporting followed STROBE guidelines.

Results

Inpatient specialist palliative care was documented for 3,266 patients (25.0%); of these, 96.7% had their first episode recorded within the final seven days of life. Documentation rates differed markedly across stroke-related diagnostic groups (p < 0.001), ranging from 37.6% in the ischaemic stroke group to 12.5% in the residual unspecified stroke group. Patients with documented inpatient specialist palliative care had higher comorbidity burden (CCI ≥ 3: 38.9% vs. 26.1%) and greater stroke-related hospital contact (88.2% vs. 62.0%). More than one quarter (27.5%) had no cerebrovascular diagnosis code recorded across any diagnosis field across hospital admissions in the final year of life despite stroke being their certified cause of death.

Conclusions

Among patients who died from stroke with hospital exposure in the final year of life, documented inpatient specialist palliative care was recorded for one in four and was concentrated in the terminal phase. The proportion of patients without hospital-recorded cerebrovascular codes suggests that stroke-specific diagnostic coding alone may not be sufficient to identify palliative care need across this population. Recurrent hospital admissions represent contact points for assessing palliative care needs. Prospective research is needed to determine for whom, and under what clinical circumstances, inpatient specialist palliative care integration improves care for patients with stroke.