Associations between home deaths and end-of-life nursing care trajectories for community-dwelling people: a population-based registry study

Kjellstadli, Camilla; Han, Ling; Allore, Heather; Flo, Elisabeth; Husebø, Bettina S.; Hunskaar, Steinar

doi:10.1186/s12913-019-4536-9

Cited by 8 publications

(11 citation statements)

References 32 publications

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“…Less than 3% of people received appropriate follow-up from their GP and died at home. This is lower than previous estimations of 4.3–6.3% of dying people with home deaths potentially planned to occur at home, based on cause of death and home nursing services ( 23 , 28 ), and far from the 15% who died at home. Numbers of home deaths are influenced by national policies, organization of health care services and family circumstances.…”

Section: Discussioncontrasting

confidence: 64%

“…We partly accounted for home nursing by investigating GPs' interdisciplinary collaboration, which is predominantly with home nursing services. People with long-term NH care are retained on the GPs' patient list and were not excluded but accounted for with a prediction model for the probability of long-term care based on previous data ( 23 , 28 ). We could not ascertain whether OOH contacts or hospital admissions were appropriate.…”

Section: Discussionmentioning

confidence: 99%

“…We previously found that only a continuously high level of home nursing services towards the end of life was associated with people dying at home, and home nursing appeared protective of NH admission ( 28 ). Overall, 7.5% received high levels of home nursing and were estimated to have a death potentially planned to occur at home; similar to the proportion of people receiving appropriate GP follow-up ( 28 ). Key elements for staying at home appear to be continuity of care, appropriate services and interdisciplinary collaboration.…”

Section: Discussionmentioning

confidence: 99%

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General practitioners' provision of end-of-life care and associations with dying at home: a registry-based longitudinal study

et al. 2020

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Background General practitioners (GPs) may play an important role in providing end-of-life care to community-dwelling people. Objective To investigate patients' contacts with GPs, GPs' interdisciplinary collaboration, out-of-hours services and hospitalizations in the last 13 weeks of life and associations with dying at home. Second, investigate whether GP contacts were associated with fewer out-of-hours contacts or days hospitalized. Methods Individually linked data from the Norwegian Cause of Death Registry, Norwegian Patient Registry, Statistics Norway and Control and Payment of Reimbursement to Health Service Providers database for all 80 813 deceased people in Norway within 2012–13. Outcomes were analyzed with logistic regression and negative binomial multilevel mixed-effect models. Results Overall, 1% of people received GP home visits in Week 13 and 4.6% in the last week before death. During the last 4 weeks of life, 9.2% received one or more GP home visits. Altogether, 6.6% received one or more home visits when the GP had one or more interdisciplinary collaborations during the last 4 weeks, of which <3% died at home. GP office consultations decreased towards the end of life. The likelihood of home death versus another location increased in relation to GP home visits [one home visit odds ratio (OR) 1.92, confidence interval (CI) 1.71–2.15; two or more OR 3.49, CI 3.08–3.96] and GP interdisciplinary collaboration (one contact OR 1.76, CI 1.59–1.96; two or more OR 2.52, CI 2.32–2.74). Conclusions GPs play a role in enabling people to die at home by performing home visits and collaborating with other health care personnel. Only a minority received such services in Norway.

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Section: Discussioncontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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General practitioners' provision of end-of-life care and associations with dying at home: a registry-based longitudinal study

et al. 2020

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“…Satisfactory palliative care in patients' homes depends on close collaboration and dialogue between the patient, family, home care nurses and general practitioners [23]. A recent Norwegian study estimated that the potential rate of planned home deaths for community dwellers was 24%, of which only a third of deaths occurred at home [24]. The same research group found that nearly 60% of those dying at home had received domiciliary care some time during the 0-90-day period prior to their death.…”

Section: Pod and Service System Capacity And Accessibilitymentioning

confidence: 99%

Relationship of place of death with care capacity and accessibility: a multilevel population study of system effects on place of death in Norway

Kalseth

Halvorsen

2020

BMC Health Serv Res

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Background: While the majority of deaths in high-income countries currently occur within institutional settings such as hospitals and nursing homes, there is considerable variation in the pattern of place of death. The place of death is known to impact many relevant considerations about death and dying, such as the quality of the dying process, family involvement in care, health services design and health policy, as well as public versus private costs of end-of-life care. The objective of this study was to analyse how the availability and capacity of publicly financed home-based and institutional care resources are related to place of death in Norway. Methods: This study utilized a dataset covering all deaths in Norway in the years 2003-2011, contrasting three places of death, namely hospital, nursing home and home. The analysis was performed using a multilevel multinomial logistic regression model to estimate the probability of each outcome while considering the hierarchical nature of factors affecting the place of death. The analysis utilized variation in health system variables at the local community and hospital district levels. The analysis was based on data from two public sources: the Norwegian Cause of Death Registry and Statistics Norway. Results: Hospital accessibility, in terms of short travel time and hospital bed capacity, was positively associated with the likelihood of hospital death. Higher capacity of nursing home beds increased the likelihood of nursing home death, and higher capacity of home care increased the likelihood of home death. Contrasting three alternative places of death uncovered a pattern of service interactions, wherein hospital and home care resources together served as an alternative to end-of-life care in nursing homes. Conclusions: Norway has a low proportion of home deaths compared with other countries. The proportion of home deaths varies between local communities. Increasing the availability of home care services is likely to enable more people to die at home, if that is what they prefer.

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“…Furthermore, interventions to increase awareness, support and education in homecare services are needed to enable more persons to die at home. Recent work found trajectories of home nursing hours and probability of short-term NH stays indicated possible effective palliative home nursing for some, while others, had not accessed services for staying at home longer at the end-of-life [ 30 ]. The authors concluded that continuity of care was an important factor in palliative home care and home death [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Reform influences location of death: Interrupted time-series analysis on older adults and persons with dementia

et al. 2020

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Background Norway instituted a Coordination Reform in 2012 aimed at maximizing time at home by providing in-home care through community services. Dying in a hospital can be highly stressful for patients and families. Persons with dementia are particularly vulnerable to negative outcomes in hospital. This study aims to describe changes in the proportion of older adults with and without dementia dying in nursing homes, home, hospital and other locations over an 11-year period covering the reform. Methods and findings This is a repeated cross-sectional, population-level study using mortality data from the Norwegian Cause of Death Registry hosted by the Norwegian Institute of Public Health. Participants were Norwegian older adults 65 years or older with and without dementia who died from 2006 to 2017. The policy intervention was the 2012 Coordination Reform that increased care infrastructure into communities. The primary outcome was location of death listed as a nursing home, home, hospital or other location. The trend in the proportion of location of death, before and after the reform was estimated using an interrupted time-series analysis. All analyses were adjusted for sex and seasonality. Of the 417,862 older adult decedents, 61,940 (14.8%) had dementia identified on their death certificate. Nursing home deaths increased over time while hospital deaths decreased for the total population (adjusted Relative Risk Ratio (aRRR) 0.87, 95% CI 0.82–0.92) and persons with dementia (aRRR: 0.93, 95%CI 0.91–0.96) after reform implementation. Conclusion This study provides evidence that the 2012 Coordination Reform was associated with decreased older adults dying in hospital and increased nursing home death; however, the number of people dying at home did not change.

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Associations between home deaths and end-of-life nursing care trajectories for community-dwelling people: a population-based registry study

Cited by 8 publications

References 32 publications

General practitioners' provision of end-of-life care and associations with dying at home: a registry-based longitudinal study

General practitioners' provision of end-of-life care and associations with dying at home: a registry-based longitudinal study

Relationship of place of death with care capacity and accessibility: a multilevel population study of system effects on place of death in Norway

Reform influences location of death: Interrupted time-series analysis on older adults and persons with dementia

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