Effectiveness of palliative home-care services in reducing hospital admissions and determinants of hospitalization for terminally ill patients followed up by a palliative home-care team: A retrospective cohort study

2013 ◽  
Vol 28 (5) ◽  
pp. 403-411 ◽  
Author(s):  
Mirko Riolfi ◽  
Alessandra Buja ◽  
Chiara Zanardo ◽  
Chiara Francesca Marangon ◽  
Pietro Manno ◽  
...  
Keyword(s):  
Cohort Study ◽  
Home Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Hospital Admissions ◽  
Terminally Ill ◽  
Home Care Services ◽  
Care Team ◽  
Palliative Home Care ◽  
Care Services

scholarly journals Comparison of Care Utilization and Institutional Death Rates among Older Adults according to Different Types of Home Care Facilities: a retrospective cohort study in Fukuoka, Japan

2020 ◽  
Author(s):  
Sung-A Kim ◽  
Akira Babazono ◽  
Aziz Jamal ◽  
Yunfei Li ◽  
Ning Liu
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Home Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Home Care Services ◽  
Care Utilization ◽  
Care Needs ◽  
Care Services ◽  
Comorbidity Index

AbstractObjectiveWe compared the use of various care services and institutional deaths in older adults among these facility types.DesignThis was a retrospective cohort study.MethodsWe used administrative claim data from April 2014 to March 2017. The study participants comprised Fukuoka Prefecture residents aged 75 and older with certified care needs of level 3 or more in April 2014 and who received home care services during the study period. Participants were divided into 4 groups according to the facility type from which they received home care services: General Clinics, Home Care Support Clinics and hospitals (HCSCs), Enhanced HCSCs with beds and Enhanced HCSCs without beds. The outcomes were utilization of medical and long-term care services and the incidence of institutional deaths. We constructed generalized linear regression models. The evaluated potential risk factors were sex, age, care needs levels, and Charlson comorbidity index (CCI) scores.ResultsThe numbers of inpatient care days were 54.3 days, 70.0 days, 64.7 days, and 75.1 days for users of enhanced HCSCs with beds, enhanced HCSCs without beds, HCSCs, and general clinics, respectively. While the number of home care days were 63.8 days, 50.9 days, 57.8 days, and 29.0 days, respectively. The odds of institutional death in general clinic users were 2.32 times higher (P<0.001) than users of enhanced HCSCs with beds.ConclusionsParticipants who used enhanced HCSCs with beds had reduced inpatient care utilization, increased home care utilization, increased home-based end-of-life care utilization, and fewer institutional deaths. These findings suggest that hospitalizations and institutional deaths could be reduced by further expanding the role of enhanced HCSCs with beds. Our study provides useful information for further investigations of home care for older adults as part of community-based integrated care.Strengths and limitations of this studyThis was a retrospective cohort study including 18,347 participants.We followed up participants for 3 years.We considered the level of care needs and Charlson comorbidity index as confounders. Despite that, the inclusion of these variables did not provide detailed information about living conditions that reflect family structure and characteristics of living.We calculated the number of years that participants lived during the study period, and the annual utilization rates per person-year of observation were estimated.There were no clinical data for individual participants because this study focused on the types of healthcare facilities that provide home care.

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.

scholarly journals Hospital-based acute care in the last 30 days of life among patients with chronic disease that received early, late or no specialist palliative care: a retrospective cohort study of eight chronic disease groups

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044196
Author(s):  
Madalene Earp ◽  
Pin Cai ◽  
Andrew Fong ◽  
Kelly Blacklaws ◽  
Truong-Minh Pham ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
Heart Disease ◽  
Chronic Disease ◽  
Acute Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Hospital Admissions ◽  
Specialist Palliative Care ◽  
Icu Admission

ObjectiveFor eight chronic diseases, evaluate the association of specialist palliative care (PC) exposure and timing with hospital-based acute care in the last 30 days of life.DesignRetrospective cohort study using administrative data.SettingAlberta, Canada between 2007 and 2016.Participants47 169 adults deceased from: (1) cancer, (2) heart disease, (3) dementia, (4) stroke, (5) chronic lower respiratory disease (chronic obstructive pulmonary disease (COPD)), (6) liver disease, (7) neurodegenerative disease and (8) renovascular disease.Main outcome measuresThe proportion of decedents who experienced high hospital-based acute care in the last 30 days of life, indicated by ≥two emergency department (ED) visit, ≥two hospital admissions,≥14 days of hospitalisation, any intensive care unit (ICU) admission, or death in hospital. Relative risk (RR) and risk difference (RD) of hospital-based acute care given early specialist PC exposure (≥90 days before death), adjusted for patient characteristics.ResultsIn an analysis of all decedents, early specialist PC exposure was associated with a 32% reduction in risk of any hospital-based acute care as compared with those with no PC exposure (RR 0.69, 95% CI 0.66 to 0.71; RD 0.16, 95% CI 0.15 to 0.17). The association was strongest in cancer-specific analyses (RR 0.53, 95% CI 0.50 to 0.55; RD 0.31, 95% CI 0.29 to 0.33) and renal disease-specific analyses (RR 0.60, 95% CI 0.43 to 0.84; RD 0.22, 95% CI 0.11 to 0.34), but a~25% risk reduction was observed for each of heart disease, COPD, neurodegenerative diseases and stroke. Early specialist PC exposure was associated with reducing risk of four out of five individual indicators of high hospital-based acute care in the last 30 days of life, including ≥two ED visit,≥two hospital admission, any ICU admission and death in hospital.ConclusionsEarly specialist PC exposure reduced the risk of hospital-based acute care in the last 30 days of life for all chronic disease groups except dementia.

Diabetes, Drug Treatment and Mortality in COVID-19: A Multinational Retrospective Cohort Study

2021 ◽  
Author(s):  
Jennifer E. Nyland ◽  
Nazia T. Raja-Khan ◽  
Kerstin Bettermann ◽  
Philippe A. Haouzi ◽  
Douglas L. Leslie ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Randomized Clinical Trials ◽  
Hospital Admissions ◽  
Inflammatory Responses ◽  
Research Network ◽  
Respiratory Complications ◽  
Dipeptidyl Peptidase 4 ◽  
Increased Risk

Patients with type 2 diabetes mellitus (T2DM) are at increased risk of severe COVID-19 outcomes possibly due to dysregulated inflammatory responses. Glucose-regulating medications such as glucagon-like peptide-1 receptor (GLP-1R) agonists, dipeptidyl peptidase-4 (DPP-4) inhibitors, and pioglitazone are known to have anti-inflammatory effects that may improve outcomes in patients with SARS-CoV-2 infection. In a multinational retrospective cohort study, we used the TriNetX COVID-19 Research Network of 56 large healthcare organizations to examine these medications in relation to the incidence of hospital admissions, respiratory complications, and mortality within 28 days following a COVID-19 diagnosis. After matching for age, sex, race, ethnicity, body mass index, and significant comorbidities, use of GLP-1R agonists and/or pioglitazone was associated with significant reductions in hospital admissions (GLP-1R: 15.7% vs 23.5%; RR, 0.67 [95% CI, 0.57-0.79]; <i>P</i> <.001; pioglitazone: 20.0% vs 28.2%; RR, 0.71 [95% CI, 0.54-0.93]; <i>P</i> =.01). Use of GLP-1R agonists was also associated with reductions in respiratory complications (15.3% vs 24.9%; RR, 0.62 [95% CI, 0.52-0.73]; <i>P</i> <.001) and incidence of mortality (1.9% vs 3.3%; RR, 0.58 [95% CI, 0.35-0.97]; <i>P</i> =.04). Use of DPP-4 inhibitors was associated with a reduction in respiratory complications (24.0% vs 29.2%; RR, 0.82 [95% CI, 0.74-0.90]; <i>P</i> <.001), and continued use of DPP-4 inhibitors after hospitalization was associated with a decrease in mortality compared with those who discontinued use (9% vs 19%; RR, 0.45 [95% CI, 0.28-0.72]; <i>P</i> <.001). In conclusion, use of glucose-regulating medications such as GLP-1R agonists, DPP-4 inhibitors, or pioglitazone may improve outcomes for COVID-19 patients with T2DM; randomized clinical trials are needed to further investigate this possibility.

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