scholarly journals Impact of palliative home care support on the quality and costs of care at the end of life: a population-level matched cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e025180 ◽  
Author(s):  
Arno Maetens ◽  
Kim Beernaert ◽  
Robrecht De Schreye ◽  
Kristof Faes ◽  
Lieven Annemans ◽  
...  
Keyword(s):  
Cohort Study ◽  
Quality Of Care ◽  
Home Care ◽  
Hospital Admission ◽  
Matched Cohort ◽  
Home Death ◽  
Palliative Home Care ◽  
Costs Of Care ◽  
Care Support

ObjectivesTo evaluate the impact of palliative home care support on the quality of care and costs in the last 14 days of life.DesignMatched cohort study using linked administrative databases.SettingAll people who died in Belgium in 2012 (n=107 847).Participants8837 people who received palliative home care support in the last 720 to 15 days of life matched 1:1 by propensity score to 8837 people who received usual care.InterventionReceiving the allowance for palliative home patients, multidisciplinary palliative home care team visit or palliative nurse or physiotherapist visit at home.Main outcome measuresHome death, number of family physician contacts, number of primary caregiver contacts, hospital death, hospital admission, intensive care unit (ICU) admission, emergency department (ED) admission, diagnostic testing, blood transfusion and surgery. Total inpatient and outpatient costs. All outcomes were measured in the last 14 days of life.ResultsIn the unmatched cohort, 11 149 (13.5%) people received palliative home care support in the last 720 to 15 days of life. After matching, those using palliative home care support had, compared with those who did not, more family physician contacts (mean 3.1 [SD=6.5] vs 0.8 [SD=1.2]), more chance of home death (56.2%vs13.8%; relative risk [RR]=4.08, 95% CI 3.86 to 4.31), lower risk of hospital admission (27.4%vs60.8%; RR=0.45, 95% CI 0.43 to 0.46), ICU admission (18.3%vs40.4%; RR=0.45, 95% CI 0.43 to 0.48) or ED admission (15.2%vs28.1%; RR=0.54, 95% CI 0.51 to 0.57). Mean total costs of care were lower for those using palliative home care support (€3081 [95% CI €3025 to €3136] vs €4698 [95% CI €4610 to €4787]; incremental cost: −€1617 [p<0.001]).ConclusionsPalliative home care support use positively impacts quality of care and reduces total costs of care at the end of life in Belgium. Policy makers and healthcare practitioners should increasingly focus on communicating the existing options for palliative home care support to patients and their caregivers.

Improved quality of care and reduced healthcare costs at the end-of-life among older people with dementia who received palliative home care: A nationwide propensity score-matched decedent cohort study

2021 ◽  
pp. 026921632110193
Author(s):  
Rose Miranda ◽  
Tinne Smets ◽  
Robrecht De Schreye ◽  
Kristof Faes ◽  
Nele Van Den Noortgate ◽  
...  
Keyword(s):  
Cohort Study ◽  
Home Care ◽  
Older People ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Palliative Home Care ◽  
People With Dementia ◽  
First Time ◽  
Care Support

Background: While palliative home care is advocated for people with dementia, evidence of its effectiveness is lacking. Aim: To evaluate the effects of palliative home care on quality and costs of end-of-life care for older people with dementia. Design: Decedent cohort study using linked nationwide administrative databases and propensity score matching. Setting/participants: All home-dwelling older people who died with dementia between 2010 and 2015 in Belgium ( N = 23,670). Exposure: Receiving palliative home care support for the first time between 360 and 15 days before death. Results: Five thousand six hundred and thirty-seven (23.8%) received palliative home care support in the last 2 years of life, of whom 2918 received it for the first time between 360 and 15 days before death. Two thousand eight hundred and thirty-nine people who received support were matched to 2839 people who received usual care. After matching, those using palliative home care support, in the last 14 days of life, had lower risk of hospital admission (17.5% vs 50.5%; relative risk (RR) = 0.21), undergoing diagnostic testing (17.0% vs 53.6%; RR = 0.20) and receiving inappropriate medications, but were more likely to die at home (75.7% vs 32.6%; RR = 6.45) and to have primary care professional contacts (mean 11.7 vs mean 5.2), compared with those who did not. Further, they had lower mean total costs of care in the last 30 days of life (incremental cost:−€2129). Conclusions: Palliative home care use by home-dwelling older people with dementia is associated with improved quality and reduced costs of end-of-life care. Access remains low and should be increased.

scholarly journals Can Palliative Home Care Reduce 30-Day Readmissions? Results of a Propensity Score Matched Cohort Study

2013 ◽  
Vol 16 (10) ◽  
pp. 1290-1293 ◽  
Author(s):  
Anjana Ranganathan ◽  
Meredith Dougherty ◽  
David Waite ◽  
David Casarett
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Home Care ◽  
Matched Cohort ◽  
Palliative Home Care ◽  
Matched Cohort Study

How can we ensure the success of specialised palliative home-care? A qualitative study (ELSAH) identifying key issues from the perspective of patients, relatives and health professionals

2021 ◽  
pp. 026921632110265
Author(s):  
Hannah Seipp ◽  
Jörg Haasenritter ◽  
Michaela Hach ◽  
Dorothée Becker ◽  
Lisa-R Ulrich ◽  
...  
Keyword(s):  
Home Care ◽  
Focus Groups ◽  
Health Professionals ◽  
Care Delivery ◽  
Death And Dying ◽  
Theory Approach ◽  
Palliative Home Care ◽  
Palliative Care Teams ◽  
Key Issues

Background: Specialised palliative home-care supports patients with life-limiting diseases in their familiar surroundings. The number of palliative care teams and patients being cared for is increasing worldwide. To assess and improve quality, it is needed to understand, how specialised palliative home-care can be provided successfully. For this purpose we examined the views of all involved stakeholders. Aim: To identify the issues that patients, their relatives and involved health professionals view as important in ensuring the success of specialised palliative home-care. Design: We used a qualitative design based on participant observations, interviews and focus groups following the principles of a Grounded Theory approach. Setting/participants: All specialised palliative home-care teams ( n = 22) caring for adults in Hesse, Germany, participated. We conducted participant observations ( n = 5), and interviewed patients ( n = 14), relatives ( n = 14) and health professionals working in or collaborating with specialised palliative home-care ( n = 30). We also conducted focus groups ( n = 4) with health professionals including a member check. Results: Successful specialised palliative home-care needs to treat complex symptoms, and provide comprehensive care including organisation of care, involving relatives and addressing issues of death and dying. Sense of security for patients and relatives is key to enable care at home. Care delivery preferences include a focus on the quality of relationships, respect for individuality and the facilitation of self-determination. Conclusions: Consideration of the identified key issues can help to ensure successful specialised palliative home-care. Knowledge of these should also be considered when researching and assessing quality of care. Trial registration: German Clinical Trials Register DRKS-ID: DRKS00012421; http://www.germanctr.de .

Health-Related Quality of Life in Primary Caregivers of People Receiving Palliative Home Care

2022 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Nadia Carolina Reina-Gamba ◽  
Judith Medellin-Olaya ◽  
Daira Vanesa Burbano-Rivera ◽  
Hilda Mireya Miranda-Rojas ◽  
Lina Maria Vargas-Escobar ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Home Care ◽  
Primary Caregivers ◽  
Health Related Quality ◽  
Palliative Home Care ◽  
Related Quality ◽  
Health Related

Guilhème Pérodeau et Denyse Côté (Eds.). Le virage ambulatoire : Défis et enjeux. Sainte-Foy, QC: Presses de l'Université du Québec. 2002.

2004 ◽  
Vol 23 (2) ◽  
pp. 191-192
Author(s):  
Aline Vézina
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Home Care ◽  
Family Member ◽  
Informal Caregivers ◽  
Nursing Personnel ◽  
Negative Consequences ◽  
The Core ◽  
Care At Home

ABSTRACTThis book is comprised of three sections: the problems and consequences of the push for more de-institutionalized health care, the issues that crop up in this context, and the perceptions of the caregiver. At the core of this text are the two groups of women who are most present in this new context: the informal caregivers or family helpers and the nurses. Three conclusions become evident. Firstly, the push for home care has many negative consequences, especially for women. Secondly, although the help of a family member makes possible the dispensation of care at home, something wished for by most patients, it also entails an increase in, and professionalization of, the tasks for the caregiving family member. Finally, using the home as the place of care also has the consequence of increasing the tasks of nursing personnel, to the point where there is a perception that the quality of care has decreased.

Quality of life before and after sinonasal surgery: a population-based matched cohort study

2016 ◽  
Vol 274 (2) ◽  
pp. 795-802 ◽  
Author(s):  
Antti I. Alakärppä ◽  
Timo J. Koskenkorva ◽  
Petri T. Koivunen ◽  
Olli-Pekka Alho
Keyword(s):  
Quality Of Life ◽  
Cohort Study ◽  
Population Based ◽  
Matched Cohort ◽  
Matched Cohort Study ◽  
Before And After

scholarly journals Cognition, functionality and symptoms in patients under home palliative care

2018 ◽  
Vol 64 (10) ◽  
pp. 922-927
Author(s):  
Maria Aparecida Scottini ◽  
Rachel Duarte Moritz ◽  
José Eduardo de Siqueira
Keyword(s):  
Home Care ◽  
Severe Pain ◽  
Symptom Assessment ◽  
Cross Sectional Study ◽  
Assessment System ◽  
Cross Sectional ◽  
Palliative Home Care ◽  
Student’S T ◽  
State Examination

SUMMARY OBJECTIVE: Evaluating the degree of cognition, functionality, presence of symptoms and medications prescribed for patients under palliative home care. METHOD: Descriptive, cross-sectional study where 55 patients under palliative home care were interviewed. Cognition was evaluated using the Mini-Mental state examination (MM), with patients being separated into two groups: with preserved cognitive ability (MM>24), or altered (MM <24). The functionality was verified by the Palliative Performance Scale (PPS) and the patients were divided into two groups: PPS≤50 and PPS≥60. The symptoms presence was evaluated by ESAS (Edmonton Symptom Assessment System) being considered as mild (ESAS 1-3), moderate (ESAS 4-6) or severe (ESAS 7-10) symptoms. Medications prescribed to control the symptoms were registered. Statistical analysis used Student's t test (p <0.05). RESULTS: Most of the 55 patients were women (63.6%), 70.9% of these had MM> 24, 83.6% had PPS <50 and 78.2% presented chronic non-neoplastic degenerative disease. There was a significant relationship between PPS≤50 and MM≤24. Symptoms were present in 98% of patients. Asthenia was more frequently reported and was not treated in 67% of the cases. Severe pain was present in 27.3%: 46% without medication and 13% with medication, if necessary. Most patients with severe dyspnea used oxygen. CONCLUSIONS: Most of the analysed patients had their cognition preserved, presented low functionality and 98% reported the presence of symptoms. Severe pain was present in almost 1/3 of the patients without effective treatment. Re-evaluate palliative home care is suggested to optimize patient's quality of life.

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