Taylor Desrosiers1, Clint Cupido2, Elizabeth Pitout3, Lindi van Niekerk2, Motasim Badri4, Liz Gwyther5, Richard Harding6. 1. Victoria Hospital, Cape Town, South Africa; Cornell University, Ithaca, New York, USA. 2. Victoria Hospital, Cape Town, South Africa; University of Cape Town, Cape Town, South Africa. 3. Victoria Hospital, Cape Town, South Africa. 4. University of Cape Town, Cape Town, South Africa. 5. University of Cape Town, Cape Town, South Africa; Hospice Palliative Care Association of South Africa, Cape Town, South Africa. 6. University of Cape Town, Cape Town, South Africa; King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, United Kingdom. Electronic address: richard.harding@kcl.ac.uk.
Abstract
CONTEXT: Despite emerging data of cost savings under palliative care in various regions, no such data have been generated in response to the high burden of terminal illness in Africa. OBJECTIVES: This evaluation of a novel hospital-based palliative care service for patients with advanced organ failure in urban South Africa aimed to determine whether the service reduces admissions and increases home death rates compared with the same fixed time period of standard hospital care. METHODS: Data on admissions and place of death were extracted from routine hospital activity records for a fixed period before death, using standard patient daily expense rates. Data from the first 56 consecutive deaths under the new service (intervention group) were compared with 48 consecutive deaths among patients immediately before the new service (historical controls). RESULTS: Among the intervention and control patients, 40 of 56 (71.4%) and 47 of 48 (97.9%), respectively, had at least one admission (P < 0.001). The mean number of admissions for the intervention and control groups was 1.39 and 1.98, respectively (P < 0.001). The mean total number of days spent admitted for intervention and control groups was 4.52 and 9.3 days, respectively (P < 0.001). For the intervention and control patients, a total of 253 and 447 admission days were recorded, respectively, with formal costs of $587 and $1209, respectively. For the intervention and control groups, home death was achieved by 33 of 56 (58.9%) and nine of 48 (18.8%), respectively (P ≤ 0.001). CONCLUSION: These data demonstrate that an outpatient hospital-based service reduced admissions and improved the rate of home deaths and offers a feasible and cost-effective model for such settings.
CONTEXT: Despite emerging data of cost savings under palliative care in various regions, no such data have been generated in response to the high burden of terminal illness in Africa. OBJECTIVES: This evaluation of a novel hospital-based palliative care service for patients with advanced organ failure in urban South Africa aimed to determine whether the service reduces admissions and increases home death rates compared with the same fixed time period of standard hospital care. METHODS: Data on admissions and place of death were extracted from routine hospital activity records for a fixed period before death, using standard patient daily expense rates. Data from the first 56 consecutive deaths under the new service (intervention group) were compared with 48 consecutive deaths among patients immediately before the new service (historical controls). RESULTS: Among the intervention and control patients, 40 of 56 (71.4%) and 47 of 48 (97.9%), respectively, had at least one admission (P < 0.001). The mean number of admissions for the intervention and control groups was 1.39 and 1.98, respectively (P < 0.001). The mean total number of days spent admitted for intervention and control groups was 4.52 and 9.3 days, respectively (P < 0.001). For the intervention and control patients, a total of 253 and 447 admission days were recorded, respectively, with formal costs of $587 and $1209, respectively. For the intervention and control groups, home death was achieved by 33 of 56 (58.9%) and nine of 48 (18.8%), respectively (P ≤ 0.001). CONCLUSION: These data demonstrate that an outpatient hospital-based service reduced admissions and improved the rate of home deaths and offers a feasible and cost-effective model for such settings.
Authors: Jiayun Xu; Joseph J Gallo; Jennifer Wenzel; Marie T Nolan; Chakra Budhathoki; Martha Abshire; Kelsey Bower; Sofia Arruda; Deirdre Flowers; Sarah L Szanton; Cheryl Dennison Himmelfarb; Kaylin Gonzalez; Hae-Ra Han Journal: J Cardiovasc Nurs Date: 2018 Jan/Feb Impact factor: 2.083
Authors: Jacques Lofandjola Masumbuku; Ernest Sumaili Kiswaya; Philippe Mairiaux; Daniel Gillain; Jean Petermans Journal: Trop Med Health Date: 2017-05-05
Authors: Maya Jane Bates; Miriam R P Gordon; Stephen B Gordon; Ewan M Tomeny; Adamson S Muula; Helena Davies; Claire Morris; Gerald Manthalu; Eve Namisango; Leo Masamba; Marc Y R Henrion; Peter MacPherson; S Bertel Squire; Louis W Niessen Journal: Lancet Glob Health Date: 2021-10-29 Impact factor: 38.927