Health service use
This report focusses on services received towards the end of life, specifically within 12 months prior to death. Exploratory analysis indicated that 98% of those with any specialist palliative care service in their last 4 years of life had a record of specialist palliative care service in their last year. The study aims to generate insights into end-of-life care, in particular what services are received, when each service was initiated and ceased (expressed as days before death), and whether these vary by patient characteristics (such as age, sex, health conditions, or care settings).
To identify health services within the last year of life, hospital and community-based records of all people who died in 2019-20 were examined for the period 1 July 2018 to 30 June 2020 (based on service date). While MBS and NDI data are available for all states and territories, the analysis using these datasets excluded WA and NT to ensure accurate comparisons with the hospital data (see Data sources).
This section provides an overview of how these services are defined, with further technical details provided in the Appendices.
Specialist palliative care services
Specialist palliative care services are comprised of multidisciplinary teams with specialised skills, competencies, experience, and training to deliver care to people where the palliative needs are complex and persistent. These services are provided in a variety of settings, including specialist inpatient consulting services, specialist inpatient care, hospices, and community-based specialist services.
In this report specialist palliative care services include:
- inpatient public hospital care where palliative care was a component of the care provided during all or part of the episode. This includes care type of palliative care or diagnosis of palliative care (Z51.5) for care type other than palliative care. Referred to as inpatient care.
- out-patient public hospital clinic services for palliative care medical consultations, usually delivered by a palliative medicine specialist or medical practitioner providing palliative care (outpatient clinic type tier 2: 20.13). Referred to as outpatient clinics.
- Medicare-subsidised services provided by a palliative medicine specialist/physician MBS claim items using service provider codes 043 or 077. Referred to as MBS palliative specialist consultations.
The definition of specialist palliative care is focussed on care delivered by palliative medicine specialists/physicians in various settings (in-patient and out-patient hospital services, and community-based services).
In this report, all relevant MBS services by palliative medicine specialists/physicians were captured by using service provider codes, including general and specific palliative care MBS service items (see Table A1, 'Medicare service provider codes'). In previous AIHW reports on MBS specialist palliative care services, specific item numbers were defined (see, for example, AIHW 2023 'Palliative care services in Australia').
Palliative care-related prescriptions from the Palliative Care Schedule are separately analysed (see Receipt of specialist palliative care, and Supplementary data tables Table 7); as are the characteristics of those in residential aged care at the time of death, comparing the groups that did and did not receive specialist palliative care (see Place of Death, and Supplementary data tables Table 2-SPC place of death).
Other services
Services in all health settings and sectors provide care to people with life-limiting illnesses. This report examines services received outside of specialised palliative care settings or providers, including attendances with GPs and nurses, consultations with non-palliative care specialists, and allied health services. These services are referred to as “other relevant services”. Although a palliative approach to care may have been a component of these services, these cannot currently be identified as such.
In this report, based on available data, other services include:
- out-patient hospital clinic services for palliative care allied health and/or clinical nurse specialist intervention (outpatient clinic type tier 2: 40.35).
- Medicare-subsidised services (MBS) – consultations with relevant medical practitioners. Includes GPs, specialist or consultant physicians who treat common life-limiting conditions (namely, oncology, cardiology, respiratory medicine, neurology, nephrology and geriatrician medicine identified by the service provider codes), practice nurse attendances, and allied health services (see Appendix Table A1 for further details).
Challenges remain for identifying when palliative care has been provided and by whom in community and primary health care settings. This approach includes the most relevant services received by people with a life-limiting illness in their last year of life outside of specialist palliative care settings or providers. However, we acknowledge that the above-mentioned MBS services may not capture all services where care was provided to people with life-limiting conditions.