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@ARTICLE{Rakua:276803,
      author       = {Rakuša, Elena and Reinke, Constantin and Doblhammer,
                      Gabriele and Radbruch, Lukas and Schmid, Matthias and
                      Welchowski, Thomas},
      title        = {{D}ementia as a predictor of palliative care: {U}ncovering
                      patient patterns based on {G}erman claims data.},
      journal      = {BMC palliative care},
      volume       = {24},
      number       = {1},
      issn         = {1472-684X},
      address      = {London},
      publisher    = {BioMed Central},
      reportid     = {DZNE-2025-00328},
      pages        = {46},
      year         = {2025},
      abstract     = {Palliative care aims to ensure a dignified and
                      self-determined life for people facing the end of life.
                      While palliative care is established for tumor diseases,
                      it's notably absent from German medical guidelines for other
                      progressive diseases with an unfavorable prognosis such as
                      dementia. This study will identify predictors of palliative
                      care use in older patients and explore how these predictors
                      relate to the probability of palliative care.We used data
                      from the largest German health insurance company of people
                      over 50 years of age from the period 2014-2019. The analysis
                      focused on the last year of life. Outcomes were outpatient
                      and inpatient palliative care and predictors were
                      demographics, comorbidities, therapeutic remedies and
                      rehabilitation, care and medical interventions, medication
                      and patient group. Combined logistic regression models and
                      discrete conditional inference survival forests were used to
                      predict the utilization of outpatient and inpatient
                      palliative care. For evaluation we used concordance-index
                      and calibration plots. We identified the most important
                      predictors by using a permutation approach and the log-loss
                      metric.The study cohort for the analysis of inpatient
                      palliative care comprised 43,896 patients, while the cohort
                      for the analysis of outpatient palliative care included a
                      total of 37,430 patients. The models had appropriate
                      discriminatory power (inpatient palliative care:
                      concordance-index = 0.737 $(95\%CI$ = 0.721-0.754);
                      outpatient palliative care: concordance-index = 0.689;
                      $95\%CI$ = 0.675-0.704) and showed appropriate calibration.
                      A diagnosis of dementia, like a diagnosis of cancer, is
                      predictive of inpatient palliative care and outpatient
                      palliative care. We observed a lower probability for
                      inpatient and for outpatient palliative care for dementia
                      patients compared to cancer patients.The findings highlight
                      the need to focus palliative care on other patient groups
                      besides cancer patients, such as dementia patients, and to
                      facilitate access for all patients.},
      keywords     = {Humans / Palliative Care: methods / Palliative Care:
                      statistics $\&$ numerical data / Palliative Care: standards
                      / Germany / Female / Male / Aged / Dementia: therapy /
                      Middle Aged / Aged, 80 and over / Cohort Studies / Insurance
                      Claim Review: statistics $\&$ numerical data / Dementia
                      (Other) / End-of-life (Other) / Machine learning (Other) /
                      Palliative care (Other) / Predictions (Other)},
      cin          = {AG Doblhammer / AG Schmid Bonn},
      ddc          = {610},
      cid          = {I:(DE-2719)1012002 / I:(DE-2719)1013028},
      pnm          = {354 - Disease Prevention and Healthy Aging (POF4-354) / 353
                      - Clinical and Health Care Research (POF4-353)},
      pid          = {G:(DE-HGF)POF4-354 / G:(DE-HGF)POF4-353},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:39966759},
      doi          = {10.1186/s12904-025-01672-y},
      url          = {https://pub.dzne.de/record/276803},
}