scholarly journals Does Increasing Home Care Nursing Reduce Emergency Department Visits at the End of Life? A Population-Based Cohort Study of Cancer Decedents

2016 ◽  
Vol 51 (2) ◽  
pp. 204-212 ◽  
Author(s):  
Hsien Seow ◽  
Lisa Barbera ◽  
Reka Pataky ◽  
Beverley Lawson ◽  
Erin O'Leary ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Home Care ◽  
End Of Life ◽  
Population Based ◽  
Emergency Department Visits ◽  
Home Care Nursing ◽  
Care Nursing

Palliative homecare is associated with reduced high- and low-acuity emergency department visits at the end of life: A population-based cohort study of cancer decedents

2016 ◽  
Vol 31 (5) ◽  
pp. 448-455 ◽  
Author(s):  
Rinku Sutradhar ◽  
Lisa Barbera ◽  
Hsien-Yeang Seow
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Confidence Interval ◽  
End Of Life ◽  
Emergency Services ◽  
Relative Rate ◽  
Population Based ◽  
Emergency Department Visits ◽  
Policy Implications ◽  
High Acuity

Background: Prior work shows that palliative homecare services reduce the subsequent need for hospitalizations and emergency services; however, no study has investigated whether this association is present for emergency department visits of high acuity or whether it only applies to low-acuity emergency department visits. Aim: To examine the association between palliative versus standard homecare nursing and the rate of high-acuity and low-acuity emergency department visits among cancer decedents during their last 6 months of life. Design: This is a retrospective cohort study of end-of-life homecare patients in Ontario, Canada, who had confirmed cancer cause of death from 2004 to 2009. A multivariable Poisson regression analysis was implemented to examine the association between the receipt of palliative homecare nursing (vs standard homecare nursing) and the rate of high- and low-acuity emergency department visits, separately. Results: There were 54,743 decedents who received homecare nursing in the last 6 months of life. The receipt of palliative homecare nursing decreased the rate of low-acuity emergency department visits (relative rate = 0.53, 95% confidence interval = 0.50–0.56) and was significantly associated with a larger decrease in the rate of high-acuity emergency department visits (relative rate = 0.37, 95% confidence interval = 0.35–0.38). Conclusion: Receiving homecare nursing with palliative intent may decrease the need for dying cancer patients to visit the emergency department, for both high and low-acuity visits, compared to receiving general homecare nursing. Policy implications include building support for additional training in palliative care to generalist homecare nurses and increasing access to palliative homecare nursing.

scholarly journals Home Care Nursing After Elective Vascular Surgery: An Opportunity to Reduce Emergency Department Visits and Hospital Readmission

2019 ◽  
Vol 70 (4) ◽  
pp. e109
Author(s):  
Charles de Mestral ◽  
Ahmed Kayssi ◽  
Mohammed Al-Omran ◽  
Konrad Salata ◽  
Mohamad A. Hussain ◽  
...  
Keyword(s):  
Emergency Department ◽  
Home Care ◽  
Vascular Surgery ◽  
Hospital Readmission ◽  
Emergency Department Visits ◽  
Home Care Nursing ◽  
Care Nursing

scholarly journals Home Care Nursing Visits and Same-Day Emergency Department Use: Which Patients Are Most at Risk?

2020 ◽  
pp. 084456212094942
Author(s):  
Connie Schumacher ◽  
Aaron Jones ◽  
Andrew P. Costa
Keyword(s):  
Emergency Department ◽  
Home Care ◽  
Service Use ◽  
Urinary Catheter ◽  
Community Dwelling ◽  
Care Needs ◽  
Home Care Nursing ◽  
Nursing Visit ◽  
Ed Visits ◽  
Care Nursing

Background Home care patients are a growing group of community-dwelling older adults with complex care needs and high health service use. Adult home care patients are at high risk for emergency department (ED) visits, which is greater on the same day as a nursing visit. Purpose The purpose of this study was to examine whether common nursing indicators modified the association between nursing visits and same-day ED visits. Methods A case-crossover design within a retrospective cohort of adult home care patients in Ontario. Results A total of 11,840 home care nursing patients were analyzed. Home care patients who received a home nursing visit were more likely to go the ED afterhours on the same day with a stronger association for visits not admitted to the hospital. Having a urinary catheter increased the risk of a same-day ED visit (OR: 1.78 (95% CI 1.15–1.60) vs. 1.21 (95% CI 1.15–1.28)). No other clinical indicator modified the association. Conclusions The findings of this study can be used to inform care policies and practices for home care nurses in the management of indwelling urinary catheter complications. Further examination of system factors such as capacity and resources available to respond to catheter related complications in the community setting are recommended.

scholarly journals Association between the level of municipality healthcare services and outcome among acutely older patients in the emergency department: a Danish population-based cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e026881 ◽  
Author(s):  
Anette Tanderup ◽  
Jesper Ryg ◽  
Jens-Ulrik Rosholm ◽  
Annmarie Touborg Lassen
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Home Care ◽  
Residential Care ◽  
Strong Predictor ◽  
Healthcare Services ◽  
Population Based ◽  
University Hospital ◽  
Secondary Outcome ◽  
Medical Patients

ObjectivesThis study aims to describe the association between use of municipality healthcare services before an emergency department (ED) contact and mortality, hospital reattendance and institutionalisation.DesignPopulation-based prospective cohort study.SettingED of a large university hospital.ParticipantsAll medical patients ≥65 years of age from a single municipality with a first attendance to the ED during a 1-year period (November 2013 to November 2014).Primary and secondary outcome measuresPatients were categorised as independent of home care, dependent of home care or in residential care depending on municipality healthcare before ED contact. Patients were followed 360 days after discharge. Outcomes were postdischarge mortality, hospital reattendance and institutionalisation.ResultsA total of 3775 patients were included (55% women), aged (median (IQR) 78 years (71–85)). At baseline, 48.9% were independent, 34.9% received home care and 16.2% were in residential care. Receiving home care or being in residential care was a strong predictor of mortality, hospital reattendance and institutionalisation. Among patients who were independent, 64.3% continued being independent up to 360 days after discharge. Even among patients ≥85 years, 35.4% lived independently in their own house 1 year after ED contact.ConclusionPrehospital information on municipality healthcare is closely related to patient outcome in older ED patients. It might have the potential to be used in risk stratification and planning of needs of older acute medical patients attending the ED.

Palliative home care and emergency department visits in the last 30 and 90 days of life: a retrospective cohort study of patients with cancer

2021 ◽  
pp. bmjspcare-2021-002889
Author(s):  
Jennifer Mracek ◽  
Madalene Earp ◽  
Aynharan Sinnarajah
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Home Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Emergency Department Visits ◽  
Palliative Home Care ◽  
Patients With Cancer ◽  
Diagnosis Of Cancer ◽  
Ed Visits

ObjectivesEvaluate the association of specialist palliative home care (HC) on emergency department (ED) visits in the 30 and 90 days prior to death.MethodsThis retrospective cohort study using administrative data identified 6976 adults deceased from cancer between 2008 and 2015, living ≥180 days after diagnosis of cancer, and residing in the urban Calgary Zone of Alberta Health Services. All palliative HC and generalist HC services were examined. Regression analyses examined the relationships of HC type to ED visits in the last 30 or 90 days of life.ResultsIn the last 30 days of life, compared with patients receiving palliative HC, patients receiving only generalist HC, or no HC, were more likely to visit the ED (OR)generalist-HC 1.19; 95% CI 1.06 to 1.34; ORno-HC 1.54; 95% CI 1.31 to 1.82). In the last 90 days of life, compared with patients receiving palliative HC, those receiving generalist HC (OR 1.48; 95% CI 1.32 to 1.67) and no HC (OR 1.66; 95% CI 1.39 to 1.99) had increased odds of visiting the ED.ConclusionsReceiving generalist HC and no HC was associated with increased odds of visiting the ED in the last 30 and 90 days of life, when compared with patients receiving palliative HC. Improving access to palliative HC for patients at high risk of visiting the ED may reduce ED visits and acute care costs and improve quality of life in the last 90 days of life.

Impact of physician-based palliative care delivery models on health care utilization outcomes: A population-based retrospective cohort study

2021 ◽  
pp. 026921632110094
Author(s):  
Catherine R L Brown ◽  
Colleen Webber ◽  
Hsien-Yeang Seow ◽  
Michelle Howard ◽  
Amy T Hsu ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Cohort Study ◽  
Healthcare Utilization ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Home Visit ◽  
Population Based ◽  
Emergency Department Visits ◽  
Care Model

Background: Increasing involvement of palliative care generalists may improve access to palliative care. It is unknown, however, if their involvement with and without palliative care specialists are associated with different outcomes. Aim: To describe physician-based models of palliative care and their association with healthcare utilization outcomes including: emergency department visits, acute hospitalizations and intensive care unit (ICU) admissions in last 30 days of life; and, place of death. Design: Population-based retrospective cohort study using linked health administrative data. We used descriptive statistics to compare outcomes across three models (generalist-only palliative care; consultation palliative care, comprising of both generalist and specialist care; and specialist-only palliative care) and conducted a logistic regression for community death. Setting/participants: All adults aged 18–105 who died in Ontario, Canada between April 1, 2012 and March 31, 2017. Results: Of the 231,047 decedents who received palliative services, 40.3% received generalist, 32.3% consultation and 27.4% specialist palliative care. Across models, we noted minimal to modest variation for decedents with at least one emergency department visit (50%–59%), acute hospitalization (64%–69%) or ICU admission (7%–17%), as well as community death (36%–40%). In our adjusted analysis, receipt of a physician home visit was a stronger predictor for increased likelihood of community death (odds ratio 9.6, 95% confidence interval 9.4–9.8) than palliative care model (generalist vs consultation palliative care 2.0, 1.9–2.0). Conclusion: The generalist palliative care model achieved similar healthcare utilization outcomes as consultation and specialist models. Including a physician home visit component in each model may promote community death.

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