Associations between physician home visits for the dying and place of death: A population-based retrospective cohort study

Abstract

BackgroundWhile most individuals wish to die at home, the reality is that most will die in hospital.AimTo determine whether receiving a physician home visit near the end-of-life is associated with lower odds of death in a hospital.DesignObservational retrospective cohort study, examining location of death and health care in the last year of life.Setting/ParticipantsPopulation-level study of Ontarians, a Canadian province with over 13 million residents. All decedents from April 1, 2010 to March 31, 2013 (n = 264,754)ResultsMore than half of 264,754 decedents died in hospital: 45.7% died in an acute care hospital and 7.7% in complex continuing care. After adjustment for multiple factors–including patient illness, home care services, and days of being at home–receiving at least one physician home visit from a non-palliative care physician was associated with a 47% decreased odds (odds-ratio, 0.53; 95%CI: 0.51–0.55) of dying in a hospital. When a palliative care physician specialist was involved, the overall odds declined by 59% (odds ratio, 0.41; 95%CI: 0.39–0.43). The same model, adjusting for physician home visits, showed that receiving palliative home care was associated with a similar reduction (odds ratio, 0.49; 95%CI: 0.47–0.51).ConclusionLocation of death is strongly associated with end-of-life health care in the home. Less than one-third of the population, however, received end-of-life home care or a physician visit in their last year of life, revealing large room for improvement.

Performance of care for end‐of‐life cancer patients in Tuscany: The interplay between place of care, aggressive treatments, opioids, and place of death. A retrospective cohort study

“…17,18 The costs of care near EOL are substantial, and some of them can be avoided (20%-30%) 19 -specifically inpatient care in the last weeks of life. 20 Reducing hospital deaths would reduce this cost, and a better allocation of resources to appropriate care settings benefits health systems by improving allocative value. 21,22 As in other care provision, there are variations among geographical areas and providers in the EOL of cancer patients.…”

“…Location of death not only influences the dying experience but also affects healthcare utilization and costs . The costs of care near EOL are substantial, and some of them can be avoided (20%‐30%)—specifically inpatient care in the last weeks of life . Reducing hospital deaths would reduce this cost, and a better allocation of resources to appropriate care settings benefits health systems by improving allocative value .…”

“…Moreover, the socioeconomic characteristics of individuals, their functional and care needs, and their support networks can have an impact together with local care practice patterns and capacity of healthcare services . An advanced debate on the appropriateness and quality of EOL care has been possible thanks to the availability of large‐scale administrative data on healthcare service use and the introduction of performance measurement systems in the healthcare sector as well as for specific clinical pathways …”

Integrating early palliative care into routine practice for patients with cancer: A mixed methods evaluation of the INTEGRATE Project

“…INTEGRATE focused on early delivery of general palliative care by oncology providers and early linkages to hospital‐ and community‐based resources, including specialized palliative care providers. Many Canadians only receive palliative care in the last month of life, and most continue to die in hospital . Weak links between hospitals and community‐based providers exacerbate limited access to and integration of palliative care for patients with cancer .…”

“…Many Canadians only receive palliative care in the last month of life, and most continue to die in hospital. [14][15][16] Weak links between hospitals and community-based providers exacerbate limited access to and integration of palliative care for patients with cancer. [17][18][19] The overall goals of INTEGRATE were to (a) enhance provider knowledge and confidence in palliative care delivery, (b) identify patients with cancer who might benefit from palliative care earlier in their disease trajectory, and (c) increase the provision of palliative care and use of palliative care tools.…”