Veronica Casotto1, Maria Rolfini2, Eliana Ferroni3, Valentina Savioli4, Nicola Gennaro5, Francesco Avossa5, Maurizio Cancian6, Franco Figoli7, Domenico Mantoan8, Antonio Brambilla9, Maria Cristina Ghiotto10, Ugo Fedeli5, Mario Saugo5. 1. Veneto Institute of Oncology IOV-IRCCS, Padova, Italy. 2. Direzione Sanità e Politiche Sociali, Emilia-Romagna Region, Italy. 3. Epidemiological System of the Veneto Region, Padova, Italy. Electronic address: eliana.ferroni@regione.veneto.it. 4. Servizio Sistema Informativo Sanità e Politiche Sociali, Emilia-Romagna Region, Italy. 5. Epidemiological System of the Veneto Region, Padova, Italy. 6. Local Health Unit n. 7, Conegliano, Italy. 7. Palliative Care Unit, Local Health Unit n. 4, Thiene, Italy. 8. Health and Social Services of the Veneto Region, Venice, Italy. 9. Assessorato Politiche per la Salute, Emilia-Romagna Region, Italy. 10. Responsabile Settore Assistenza Distrettuale e Cure Primarie, Veneto Region, Italy.
Abstract
CONTEXT: Frequent end-of-life health care setting transitions can lead to an increased risk of fragmented care and exposure to unnecessary treatments. OBJECTIVES: We assessed the relationship between the presence and the intensity of an Integrated Cancer Palliative Care (ICPC) plan and the occurrence of multiple transitions during the last month of life. METHODS: Decedents of cancer aged 18-85 years residents in two regions of Italy were investigated accessing their integrated administrative data (death certificates, hospital discharges, hospice, and home care records). The principal outcome was defined as having 3+ health care setting transitions during the last month of life. The ICPC plans instituted 90-31 days before death represented the main exposure of interest. RESULTS: Of the 17,604 patients, 6698 included in an ICPC, although spending in hospital a median number of only two days (interquartile range 1-2), experienced 1+ (59.8%), 2+ (21.1%), or 3+ (5.9%) health care transitions. Among the latter group, the most common trajectory of care is home-hospital-home-hospital (36.0%). The intensity of the ICPC plan showed a marked protective effect toward the event of 3+ health care setting transitions; the effect is already evident from an intensity of at least one home visit/week (odds ratio 0.73; 95% confidence interval 0.62-0.87). CONCLUSION: A well-integrated palliative care approach can be effective in further reducing the percentage of patients who spent many days in hospital and/or undergo frequent and inopportune changes of their care setting during their last month of life.
CONTEXT: Frequent end-of-life health care setting transitions can lead to an increased risk of fragmented care and exposure to unnecessary treatments. OBJECTIVES: We assessed the relationship between the presence and the intensity of an Integrated Cancer Palliative Care (ICPC) plan and the occurrence of multiple transitions during the last month of life. METHODS: Decedents of cancer aged 18-85 years residents in two regions of Italy were investigated accessing their integrated administrative data (death certificates, hospital discharges, hospice, and home care records). The principal outcome was defined as having 3+ health care setting transitions during the last month of life. The ICPC plans instituted 90-31 days before death represented the main exposure of interest. RESULTS: Of the 17,604 patients, 6698 included in an ICPC, although spending in hospital a median number of only two days (interquartile range 1-2), experienced 1+ (59.8%), 2+ (21.1%), or 3+ (5.9%) health care transitions. Among the latter group, the most common trajectory of care is home-hospital-home-hospital (36.0%). The intensity of the ICPC plan showed a marked protective effect toward the event of 3+ health care setting transitions; the effect is already evident from an intensity of at least one home visit/week (odds ratio 0.73; 95% confidence interval 0.62-0.87). CONCLUSION: A well-integrated palliative care approach can be effective in further reducing the percentage of patients who spent many days in hospital and/or undergo frequent and inopportune changes of their care setting during their last month of life.