Katrina Spilsbury1, Lorna Rosenwax2, Glenn Arendts3, James B Semmens1. 1. Centre for Population Health Research, Faculty of Health Sciences, Curtin University, Perth, Western Australia. 2. School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, Perth, Western Australia. Electronic address: l.rosenwax@curtin.edu.au. 3. Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research and the University of Western Australia, and the Department of Emergency Medicine, Royal Perth Hospital, Perth, Western Australia.
Abstract
STUDY OBJECTIVE: Palliative care has been shown to reduce end-of-life emergency department (ED) use. Our objective was to determine how the association of community-based palliative care with reduced ED visits in the last year of life varied by patient factors. METHODS: This was a retrospective cohort study of 11,875 decedents who died with neoplasms, heart failure, renal failure, chronic obstructive pulmonary disease, or liver failure in Western Australia in 2009 to 2010. Outcome measures were adjusted hazard ratios (HRs) and daily (hazard) rates of ED visits. RESULTS: The adjusted average rate of ED visits for the cohort was reduced 50% (HR 0.50; 95% confidence interval [CI] 0.47 to 0.53) during periods of receipt of community-based palliative care. This relative reduction in ED visits varied by patient factors, ranging from 43% (HR 0.57; 95% CI 0.45 to 0.74) for decedents aged 60 years and younger up to 71% (HR 0.29; 95% CI 0.18 to 0.46) for people aged 90 years and older. Decedents living in the most disadvantaged areas had a 44% (HR 0.56; 95% CI 0.44 to 0.72) reduction in ED visits when receiving community-based palliative care compared with a 60% (HR 0.40; 95% CI 0.31 to 0.53) reduction for decedents who lived in the least disadvantaged areas and received this care. The ED visit rates while patients were receiving palliative care also varied by ED visit history, partner status, and region of residence. CONCLUSION: Receipt of community-based palliative care in the last year of life was associated with a reduced rate of ED visits. The magnitude of this association was modified by patient health, as well as social and demographic factors.
STUDY OBJECTIVE: Palliative care has been shown to reduce end-of-life emergency department (ED) use. Our objective was to determine how the association of community-based palliative care with reduced ED visits in the last year of life varied by patient factors. METHODS: This was a retrospective cohort study of 11,875 decedents who died with neoplasms, heart failure, renal failure, chronic obstructive pulmonary disease, or liver failure in Western Australia in 2009 to 2010. Outcome measures were adjusted hazard ratios (HRs) and daily (hazard) rates of ED visits. RESULTS: The adjusted average rate of ED visits for the cohort was reduced 50% (HR 0.50; 95% confidence interval [CI] 0.47 to 0.53) during periods of receipt of community-based palliative care. This relative reduction in ED visits varied by patient factors, ranging from 43% (HR 0.57; 95% CI 0.45 to 0.74) for decedents aged 60 years and younger up to 71% (HR 0.29; 95% CI 0.18 to 0.46) for people aged 90 years and older. Decedents living in the most disadvantaged areas had a 44% (HR 0.56; 95% CI 0.44 to 0.72) reduction in ED visits when receiving community-based palliative care compared with a 60% (HR 0.40; 95% CI 0.31 to 0.53) reduction for decedents who lived in the least disadvantaged areas and received this care. The ED visit rates while patients were receiving palliative care also varied by ED visit history, partner status, and region of residence. CONCLUSION: Receipt of community-based palliative care in the last year of life was associated with a reduced rate of ED visits. The magnitude of this association was modified by patient health, as well as social and demographic factors.
Authors: Daniel G Miller; J Priyanka Vakkalanka; Morgan B Swanson; Andrew S Nugent; Yuya Hagiwara Journal: Am J Hosp Palliat Care Date: 2020-07-02 Impact factor: 2.500
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
Authors: Anne Kamphausen; Hanna Roese; Karin Oechsle; Malte Issleib; Christian Zöllner; Carsten Bokemeyer; Anneke Ullrich Journal: Emerg Med Int Date: 2019-11-26 Impact factor: 1.112