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Comparative Study
. 2014 Jun 6:348:g3496.
doi: 10.1136/bmj.g3496.

Impact of community based, specialist palliative care teams on hospitalisations and emergency department visits late in life and hospital deaths: a pooled analysis

Hsien Seow  1 , Kevin Brazil  2 , Jonathan Sussman  3 , José Pereira  4 , Denise Marshall  5 , Peter C Austin  6 , Amna Husain  7 , Jagadish Rangrej  8 , Lisa Barbera  9
Affiliations
Comparative Study

Impact of community based, specialist palliative care teams on hospitalisations and emergency department visits late in life and hospital deaths: a pooled analysis

Hsien Seow et al. BMJ. .

Abstract

Objective: To determine the pooled effect of exposure to one of 11 specialist palliative care teams providing services in patients' homes.

Design: Pooled analysis of a retrospective cohort study.

Setting: Ontario, Canada.

Participants: 3109 patients who received care from specialist palliative care teams in 2009-11 (exposed) matched by propensity score to 3109 patients who received usual care (unexposed).

Intervention: The palliative care teams studied served different geographies and varied in team composition and size but had the same core team members and role: a core group of palliative care physicians, nurses, and family physicians who provide integrated palliative care to patients in their homes. The teams' role was to manage symptoms, provide education and care, coordinate services, and be available without interruption regardless of time or day.

Main outcome measures: Patients (a) being in hospital in the last two weeks of life; (b) having an emergency department visit in the last two weeks of life; or (c) dying in hospital.

Results: In both exposed and unexposed groups, about 80% had cancer and 78% received end of life homecare services for the same average duration. Across all palliative care teams, 970 (31.2%) of the exposed group were in hospital and 896 (28.9%) had an emergency department visit in the last two weeks of life respectively, compared with 1219 (39.3%) and 1070 (34.5%) of the unexposed group (P<0.001). The pooled relative risks of being in hospital and having an emergency department visit in late life comparing exposed versus unexposed were 0.68 (95% confidence interval 0.61 to 0.76) and 0.77 (0.69 to 0.86) respectively. Fewer exposed than unexposed patients died in hospital (503 (16.2%) v 887 (28.6%), P<0.001), and the pooled relative risk of dying in hospital was 0.46 (0.40 to 0.52).

Conclusions: Community based specialist palliative care teams, despite variation in team composition and geographies, were effective at reducing acute care use and hospital deaths at the end of life.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: three authors (AH, JP, DM) are physicians in three of the palliative care teams and provided access to data, but were not involved in the data analysis; the remaining authors have no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Relative risk of being in hospital in the last two weeks of life for exposed patients (care from specialist palliative care team) and unexposed patients (usual care)
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Fig 2 Relative risk of an emergency department visit in the last two weeks of life for exposed patients (care from specialist palliative care team) and unexposed patients (usual care)
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Fig 3 Relative risk of dying in hospital for exposed patients (care from specialist palliative care team) and unexposed patients (usual care)
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