Authors (including presenting author) :
Mo MYT(1), Woo WSS(1), Wong CK(1), Po MYY(1), Chan K(1), Kng CPL(1)
Affiliation :
(1) Department of Medicine & Geriatrics, Ruttonjee and Tang Shiu Kin Hospital
Introduction :
Elderly living in residential care home for the elderly (RCHE) in Hong Kong have multiple co-morbidities with unpredictable illness trajectories leading to death, with increasing demand for end-of-life (EOL) care. Repeated admissions prior to death in hospitals is the norm in HK. The Hospital Admission Risk Reduction Program for the Elderly (HARRPE) score has been shown to correlate with mortality but the feasibility to use it as a potential tool to aid case identification has not been tested.
Objectives :
To compare Advance Care Planning (ACP) acceptance rate and mortality at 180 and 365 days of patients recruited to HKEC CGAS EOL program identified by HARRPE score versus clinical referrals.
Methodology :
A retrospective cohort study comparing RCHE elderly referred between 1st July 2018 to 30th June 2019 by clinical referrals (Clin_EOL) versus the HARRPE_EOL group which recruited aged ≥80 with HARRPE score ≥0.4, based on high mortality observed in a previous study. Outcomes were compared between both groups during follow period up to 3 years.
Result & Outcome :
The EOL team assessed 113 Clin_EOL and 735 HARRPE_EOL patients, of which 102 and 96 respectively fulfilled criteria for HKEC EOL program. Their mean age was 92 with female predominance (71%). The ACP acceptance rate was similar in both groups; 57% for Clin_EOL and 51% for HARRPE_EOL. Of those with ACP, the survival probability is higher compared to those without (P<0.001). For Clin_EOL, 52% and 62% died at 180 and 365-day respectively and 48% and 66% for HARRPE_EOL. The overall mortality for both groups were similar (log rank test, P=0.801). In conclusion, elderly in RCHE requiring EOL care identified by HARRPE score showed equivalent ACP acceptance and mortality rate compared with referrals by clinicians. HARRPE score is a feasible automated tool to supplement clinical referral through automation for timely EOL care.
