Hsien Seow1, Gagan Dhaliwal2, Konrad Fassbender3, Jagadish Rangrej4, Kevin Brazil5, Robin Fainsinger3. 1. 1 Department of Oncology, Hamilton, Ontario, Canada . 2. 2 McMaster University , Hamilton, Ontario, Canada . 3. 3 Department of Oncology, University of Alberta , Edmonton, Alberta, Canada . 4. 4 Institute for Clinical Evaluative Sciences , Toronto, Ontario, Canada . 5. 5 School of Nursing and Midwifery, Queen's University Belfast , Belfast, Northern Ireland, United Kingdom .
Abstract
BACKGROUND: Prior research on community-based specialist palliative care teams used outcome measures of place of death and/or dichotomous outcome measures of acute care use in the last two weeks of life. However, existing research seldom measured the diverse places of care used and their timing prior to death. OBJECTIVE: The study objective was to examine the place of care in the last 30 days of life. METHODS: In this retrospective cohort study, patients who received care from a specialist palliative care team (exposed) were matched by propensity score to patients who received usual care in the community (unexposed) in Ontario, Canada. Measured was the percentage of patients in each place of care in the last month of life as a proportion of the total cohort. RESULTS: After matching, 3109 patients were identified in each group, where 79% had cancer and 77% received end-of-life home care. At 30 days compared to 7 days before death, the exposed group's proportions rose from 33% to 41% receiving home care and 14% to 15% in hospital, whereas the unexposed group's proportions rose from 28% to 32% receiving home care and 16% to 22% in hospital. Linear trend analysis (proportion over time) showed that the exposed group used significantly more home care services and fewer hospital days (p < 0.001) than the unexposed group. On the last day of life (place of death), the exposed group had 18% die in an in-patient hospital bed compared to 29% in usual care. CONCLUSION: Examining place of care in the last month can effectively illustrate the service use trajectory over time.
BACKGROUND: Prior research on community-based specialist palliative care teams used outcome measures of place of death and/or dichotomous outcome measures of acute care use in the last two weeks of life. However, existing research seldom measured the diverse places of care used and their timing prior to death. OBJECTIVE: The study objective was to examine the place of care in the last 30 days of life. METHODS: In this retrospective cohort study, patients who received care from a specialist palliative care team (exposed) were matched by propensity score to patients who received usual care in the community (unexposed) in Ontario, Canada. Measured was the percentage of patients in each place of care in the last month of life as a proportion of the total cohort. RESULTS: After matching, 3109 patients were identified in each group, where 79% had cancer and 77% received end-of-life home care. At 30 days compared to 7 days before death, the exposed group's proportions rose from 33% to 41% receiving home care and 14% to 15% in hospital, whereas the unexposed group's proportions rose from 28% to 32% receiving home care and 16% to 22% in hospital. Linear trend analysis (proportion over time) showed that the exposed group used significantly more home care services and fewer hospital days (p < 0.001) than the unexposed group. On the last day of life (place of death), the exposed group had 18% die in an in-patient hospital bed compared to 29% in usual care. CONCLUSION: Examining place of care in the last month can effectively illustrate the service use trajectory over time.
Authors: Kieran L Quinn; Therese Stukel; Nathan M Stall; Anjie Huang; Sarina Isenberg; Peter Tanuseputro; Russell Goldman; Peter Cram; Dio Kavalieratos; Allan S Detsky; Chaim M Bell Journal: BMJ Date: 2020-07-06
Authors: Kieran L Quinn; Amy T Hsu; Glenys Smith; Nathan Stall; Allan S Detsky; Dio Kavalieratos; Douglas S Lee; Chaim M Bell; Peter Tanuseputro Journal: J Am Heart Assoc Date: 2020-02-19 Impact factor: 5.501
Authors: Outi M Hirvonen; Riikka-Leena Leskelä; Lotta Grönholm; Olli Haltia; Samuli Voltti; Kristiina Tyynelä-Korhonen; Eeva K Rahko; Juho T Lehto; Tiina Saarto Journal: BMC Palliat Care Date: 2020-03-24 Impact factor: 3.234