David Casarett1, Joan Harrold2, Pamela S Harris3, Laura Bender4, Sue Farrington5, Eugenia Smither6, Kevin Ache7, Joan Teno8. 1. Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA. Electronic address: Casarett@mail.med.upenn.edu. 2. Hospice and Community Care, Lancaster, Pennsylvania, USA. 3. Kansas City Hospice & Palliative Care, Kansas City, Missouri, USA. 4. Penn Home Care and Hospice Services, Philadelphia, Pennsylvania, USA. 5. Suncoast Solutions Incorporated, Tampa, Florida, USA. 6. Hospice of the Bluegrass, Lexington, Kentucky, USA. 7. Suncoast Hospice, Tampa, Florida, USA. 8. Brown University, Providence, Rhode Island, USA.
Abstract
CONTEXT: In the U. S., hospices sometimes provide high-intensity "continuous care" in patients' homes. However, little is known about the way that continuous care is used or what impact continuous care has on patient outcomes. OBJECTIVES: To describe patients who receive continuous care and determine whether continuous care reduces the likelihood that patients will die in an inpatient unit or hospital. METHODS: Data from 147,137 patients admitted to 11 U.S. hospices between 2008 and 2012 were extracted from the electronic medical records. The hospices are part of a research-focused collaboration. The study used a propensity score-matched cohort design. RESULTS: A total of 99,687 (67.8%) patients were in a private home or nursing home on the day before death, and of these, 10,140 (10.2%) received continuous care on the day before death. A propensity score-matched sample (n = 24,658) included 8524 patients who received continuous care and 16,134 patients who received routine care on the day before death. Using the two matched groups, patients who received continuous care on the day before death were significantly less likely to die in an inpatient hospice setting (350/8524 vs. 2030/16,134; 4.1% vs. 12.6%) (odds ratio [OR] 0.29; 95% CI 0.27-0.34; P < 0.001). When patients were cared for by a spouse, the use of continuous care was associated with a larger decrease in inpatient deaths (OR 0.12; 95% CI 0.09-0.16; P < 0.001) compared with those patients cared for by other family members (OR 0.37; 95% CI 0.32-0.42; P < 0.001). It is possible that unmeasured covariates were not included in the propensity score match. CONCLUSION: Use of continuous care on the day before death is associated with a significant reduction in the use of inpatient care on the last day of life, particularly when patients are cared for by a spouse.
CONTEXT: In the U. S., hospices sometimes provide high-intensity "continuous care" in patients' homes. However, little is known about the way that continuous care is used or what impact continuous care has on patient outcomes. OBJECTIVES: To describe patients who receive continuous care and determine whether continuous care reduces the likelihood that patients will die in an inpatient unit or hospital. METHODS: Data from 147,137 patients admitted to 11 U.S. hospices between 2008 and 2012 were extracted from the electronic medical records. The hospices are part of a research-focused collaboration. The study used a propensity score-matched cohort design. RESULTS: A total of 99,687 (67.8%) patients were in a private home or nursing home on the day before death, and of these, 10,140 (10.2%) received continuous care on the day before death. A propensity score-matched sample (n = 24,658) included 8524 patients who received continuous care and 16,134 patients who received routine care on the day before death. Using the two matched groups, patients who received continuous care on the day before death were significantly less likely to die in an inpatient hospice setting (350/8524 vs. 2030/16,134; 4.1% vs. 12.6%) (odds ratio [OR] 0.29; 95% CI 0.27-0.34; P < 0.001). When patients were cared for by a spouse, the use of continuous care was associated with a larger decrease in inpatient deaths (OR 0.12; 95% CI 0.09-0.16; P < 0.001) compared with those patients cared for by other family members (OR 0.37; 95% CI 0.32-0.42; P < 0.001). It is possible that unmeasured covariates were not included in the propensity score match. CONCLUSION: Use of continuous care on the day before death is associated with a significant reduction in the use of inpatient care on the last day of life, particularly when patients are cared for by a spouse.
Authors: Veerawat Phongtankuel; P Johnson; M C Reid; R D Adelman; Z Grinspan; M A Unruh; E Abramson Journal: Am J Hosp Palliat Care Date: 2016-07-22 Impact factor: 2.500
Authors: Karla T Washington; George Demiris; Debra Parker Oliver; Gemille Purnell; Paul Tatum Journal: J Am Med Dir Assoc Date: 2017-09-30 Impact factor: 4.669
Authors: Jennifer M Reckrey; Katherine A Ornstein; Karen McKendrick; Emma K Tsui; R Sean Morrison; Melissa Aldridge Journal: J Pain Symptom Manage Date: 2021-12-23 Impact factor: 3.612
Authors: Heidi Kern; Giorgio Corani; David Huber; Nicola Vermes; Marco Zaffalon; Marco Varini; Claudia Wenzel; André Fringer Journal: BMC Palliat Care Date: 2020-10-15 Impact factor: 3.234