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

PLoS One. 2018 Feb 15;13(2):e0191322. doi: 10.1371/journal.pone.0191322. eCollection 2018.


Background: While most individuals wish to die at home, the reality is that most will die in hospital.

Aim: To determine whether receiving a physician home visit near the end-of-life is associated with lower odds of death in a hospital.

Design: Observational retrospective cohort study, examining location of death and health care in the last year of life.

Setting/participants: Population-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).

Results: More 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).

Conclusion: Location 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Canada
  • Cohort Studies
  • Death
  • Female
  • Home Care Services / statistics & numerical data
  • Home Care Services / trends
  • Hospice Care / trends
  • Hospitalization / trends
  • Hospitals / statistics & numerical data*
  • Hospitals / trends
  • House Calls / statistics & numerical data*
  • Humans
  • Male
  • Odds Ratio
  • Palliative Care
  • Physicians
  • Quality of Life
  • Retrospective Studies
  • Terminal Care / methods*
  • Terminal Care / trends

Grants and funding

This research was supported by a research grant from the Ontario Ministry of Health and Long Term Care (MOHLTC) to the Health System Performance Research Network Grant (HSPRN #06034). This study was also supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario MOHLTC. PT is supported through the Bruyère Research Institute. The views expressed in this paper are the views of the authors and do not necessarily reflect those of the funder. The funders had no influence on the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.