Early initiation of palliative care is associated with reduced late-life acute-hospital use: A population-based retrospective cohort study

Palliat Med. 2019 Feb;33(2):150-159. doi: 10.1177/0269216318815794. Epub 2018 Dec 3.


Background:: Early palliative care can reduce end-of-life acute-care use, but findings are mainly limited to cancer populations receiving hospital interventions. Few studies describe how early versus late palliative care affects end-of-life service utilization.

Aim:: To investigate the association between early versus late palliative care (hospital/community-based) and acute-care use and other publicly funded services in the 2 weeks before death.

Design:: Retrospective population-based cohort study using linked administrative healthcare data.

Setting/participants:: Decedents (cancer, frailty, and organ failure) between 1 April 2010 and 31 December 2012 in Ontario, Canada. Initiation time before death (days): early (⩾60) and late (⩾15 and <60). ‘Acute-care settings’ included acute-hospital admissions with (‘palliative-acute-care’) and without palliative involvement (‘non-palliative-acute-care’).

Results:: We identified 230,921 decedents. Of them, 27% were early palliative care recipients and 13% were late; 45% of early recipients had a community-based initiation and 74% of late recipients had a hospital-based initiation. Compared to late recipients, fewer early recipients used palliative-acute care (42% vs 65%) with less days (mean days: 9.6 vs 12.0). Late recipients were more likely to use acute-care settings; this was further modified by disease: comparing late to early recipients, cancer decedents were nearly two times more likely to spend >1 week in acute-care settings (odds ratio = 1.84, 95% confidence interval: 1.83–1.85), frailty decedents were three times more likely (odds ratio = 3.04, 95% confidence interval: 3.01–3.07), and organ failure decedents were four times more likely (odds ratio = 4.04, 95% confidence interval: 4.02–4.06).

Conclusion:: Early palliative care was associated with improved end-of-life outcomes. Late initiations were associated with greater acute-care use, with the largest influence on organ failure and frailty decedents, suggesting potential opportunities for improvement.

Keywords: Canada; Palliative care; administrative claims; cohort studies; end-of-life care; health services; healthcare; hospitalization.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Canada
  • Cohort Studies
  • Critical Care / statistics & numerical data*
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Home Care Services / statistics & numerical data*
  • Hospitalization / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Palliative Care / statistics & numerical data*
  • Retrospective Studies
  • Terminal Care / statistics & numerical data*
  • Time Factors*
  • Young Adult