The impact of community-based palliative care on acute hospital use in the last year of life is modified by time to death, age and underlying cause of death. A population-based retrospective cohort study

Objective: To compare emergency department (ED) presentations and hospital admissions for urgent early pregnancy conditions in Victoria before and after the onset of COVID-19 lockdown on 31 March 2020. Design: Population-based retrospective cohort study Setting: Australian state of Victoria Population: Pregnant women presenting to emergency departments or admitted to hospital Methods: We obtained state-wide hospital separation data from the Victorian Emergency Minimum Dataset and the Victorian Admitted Episodes Dataset from January 1, 2018, to October 31, 2020. A linear prediction model based on the pre-COVID period was used to identify the impact of COVID restrictions. Main outcome measures: Monthly ED presentations for miscarriage and ectopic pregnancy, hospital admissions for termination of pregnancy, with subgroup analysis by region, socioeconomic status, disease acuity, hospital type. Results: There was an overall decline in monthly ED presentations and hospital admissions for early pregnancy conditions in metropolitan areas where lockdown restrictions were most stringent. Monthly ED presentations for miscarriage during the COVID period were consistently below predicted, with the nadir in April 2020 (790 observed vs 985 predicted, 95% CI 835-1135). Monthly admissions for termination of pregnancy were also below predicted throughout lockdown, with the nadir in August 2020 (893 observed vs 1116 predicted, 95% CI 905-1326). There was no increase in ED presentations for complications following abortion, ectopic or molar pregnancy during the COVID period. Conclusions: Fewer women in metropolitan Victoria utilized hospital-based care for early pregnancy conditions during the first seven months of the pandemic, without any observable increase in maternal morbidity.

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The impact of the duration of the palliative care period on cancer patients with regard to the use of hospital services and the place of death: a retrospective cohort study

BMC Palliative Care ◽

10.1186/s12904-020-00547-8 ◽

2020 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Outi M. Hirvonen ◽

Riikka-Leena Leskelä ◽

Lotta Grönholm ◽

Olli Haltia ◽

Samuli Voltti ◽

...

Keyword(s):

Palliative Care ◽

Cohort Study ◽

Cancer Patients ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Place Of Death ◽

Hospital Services ◽

The Impact ◽

Care Period

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Palliative care in paramedic practice: A retrospective cohort study

Palliative Medicine ◽

10.1177/0269216319828278 ◽

2019 ◽

Vol 33 (4) ◽

pp. 445-451 ◽

Cited By ~ 5

Author(s):

Bill Lord ◽

Emily Andrew ◽

Amanda Henderson ◽

David J Anderson ◽

Karen Smith ◽

...

Keyword(s):

Palliative Care ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Systems Of Care ◽

Community Based ◽

Health Crisis ◽

Australian State ◽

History Of ◽

Hospital Transport

Background: Paramedics may be involved in the care of patients experiencing a health crisis associated with palliative care. However, little is known about the paramedic’s role in the care of these patients. Aim: To describe the incidence and nature of cases attended by paramedics and the care provided where the reason for attendance was associated with a history of palliative care. Design: This is a retrospective cohort study. Setting/participants: Adult patients (aged >17 years) attended by paramedics in the Australian state of Victoria between 1 July 2015 and 30 June 2016 where terms associated with palliative care or end of life were recorded in the patient care record. Secondary transfers including inter-hospital transport cases were excluded. Results: A total of 4348 cases met inclusion criteria. Median age was 74 years (interquartile range 64–83). The most common paramedic assessments were ‘respiratory’ (20.1%), ‘pain’ (15.8%) and ‘deceased’ (7.9%); 74.4% ( n = 3237) were transported, with the most common destination being a hospital (99.5%, n = 3221). Of those with pain as the primary impression, 359 (53.9%) received an analgesic, morphine, fentanyl or methoxyflurane, and 356 (99.2%) were transported following analgesic administration. Resuscitation was attempted in 98 (29.1%) of the 337 cases coded as cardiac arrest. Among non-transported cases, there were 105 (9.6%) cases where paramedics re-attended the patient within 24 h of the previous attendance. Conclusion: Paramedics have a significant role in caring for patients receiving palliative care. These results should inform the design of integrated systems of care that involve ambulance services in the planning and delivery of community-based palliative care.

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Community-based palliative care is associated with reduced emergency department use by people with dementia in their last year of life: A retrospective cohort study

Palliative Medicine ◽

10.1177/0269216315576309 ◽

2015 ◽

Vol 29 (8) ◽

pp. 727-736 ◽

Cited By ~ 34

Author(s):

Lorna Rosenwax ◽

Katrina Spilsbury ◽

Glenn Arendts ◽

Bev McNamara ◽

James Semmens

Keyword(s):

Emergency Department ◽

Palliative Care ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Community Based ◽

Emergency Department Use ◽

People With Dementia

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

Palliative Medicine ◽

10.1177/02692163211009440 ◽

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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Use of gastric acid–suppressive agents increases the risk of dementia in patients with upper gastrointestinal disease: A population-based retrospective cohort study

PLoS ONE ◽

10.1371/journal.pone.0249050 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0249050

Author(s):

Hsiu-Chen Lin ◽

Kuan-Tzu Huang ◽

Hsiu-Li Lin ◽

Yow-Sheng Uang ◽

Yi Ho ◽

...

Keyword(s):

Cohort Study ◽

Gastric Acid ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Gastrointestinal Disease ◽

Asian Population ◽

Population Based ◽

Increased Risk ◽

The Impact ◽

Upper Gastrointestinal

Background Prescriptions for gastric acid–suppressive agents, including proton-pump inhibitors (PPIs) and histamine type-2 receptor antagonists (H2RAs), are rising. However, little data exist regarding their association with dementia in the Asian population. The objective of this study was thus to investigate the impact of the use of PPIs and H2RAs on the risk of dementia in an Asian population with upper gastrointestinal disease (UGID). Methods We conducted a population-based retrospective cohort study with a 10-year follow-up using data from 2000 to 2015 derived from Taiwan’s Longitudinal Health Insurance Database. We included 6711 patients with UGID receiving gastric acid–suppressive agents, 6711 patients with UGID not receiving agents, and 6711 patients without UGID or treatment thereof, all at least 20 years of age. Groups were matched for age, sex, and index date. The association between gastric acid–suppressive agent use and dementia was analyzed using a Cox proportional hazards regression model adjusted for potential confounders. Results The adjusted hazard ratio (aHR) of dementia for patients with UGID receiving gastric acid–suppressive agents compared with patients with UGID without gastric acid–suppressive agents was 1.470 (95% confidence interval [CI] 1.267–1.705, p < 0.001). Both PPIs and H2RAs increase the risk of dementia (PPIs: aHR 1.886 [95% CI 1.377–2.582], p < 0.001; H2RAs: aHR 1.357 [95% CI 1.098–1.678], p < 0.01), with PPIs exhibiting significantly greater risk (aHR 1.456 [95% CI 1.022–2.075], p < 0.05). Conclusions Our results demonstrate an increased risk of dementia in patients with UGID receiving gastric acid–suppressive agents, including PPIs and H2RAs, and the use of PPIs was associated with a significantly greater risk than H2RA use.

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How are physicians delivering palliative care? A population-based retrospective cohort study describing the mix of generalist and specialist palliative care models in the last year of life

Palliative Medicine ◽

10.1177/0269216318780223 ◽

2018 ◽

Vol 32 (8) ◽

pp. 1334-1343 ◽

Cited By ~ 14

Author(s):

Catherine RL Brown ◽

Amy T Hsu ◽

Claire Kendall ◽

Denise Marshall ◽

Jose Pereira ◽

...

Keyword(s):

Palliative Care ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Family Physicians ◽

Population Based ◽

Specialist Palliative Care ◽

Care Services ◽

Palliative Care Services ◽

Generalist Palliative Care

Background: To enable coordinated palliative care delivery, all clinicians should have basic palliative care skill sets (‘generalist palliative care’). Specialists should have skills for managing complex and difficult cases (‘specialist palliative care’) and co-exist to support generalists through consultation care and transfer of care. Little information exists about the actual mixes of generalist and specialist palliative care. Aim: To describe the models of physician-based palliative care services delivered to patients in the last 12 months of life. Design: This is a population-based retrospective cohort study using linked health care administrative data. Setting/participants: Physicians providing palliative care services to a decedent cohort in Ontario, Canada. The decedent cohort consisted of all adults (18+ years) who died in Ontario, Canada between April 2011 and March 2015 ( n = 361,951). Results: We describe four major models of palliative care services: (1) 53.0% of decedents received no physician-based palliative care, (2) 21.2% received only generalist palliative care, (3) 14.7% received consultation palliative care (i.e. care from both specialists and generalists), and (4) 11.1% received only specialist palliative care. Among physicians providing palliative care ( n = 11,006), 95.3% had a generalist palliative care focus and 4.7% a specialist focus; 74.2% were trained as family physicians. Conclusion: We examined how often a coordinated palliative care model is delivered to a large decedent cohort and identified that few actually received consultation care. The majority of care, in both the palliative care generalist and specialist models, was delivered by family physicians. Further research should evaluate how different models of care impact patient outcomes and costs.

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