Who finds the road to palliative home care support? A nationwide analysis on the use of supportive measures for palliative home care using linked administrative databases

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.

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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 ◽

10.1136/bmjopen-2018-025180 ◽

2019 ◽

Vol 9 (1) ◽

pp. e025180 ◽

Cited By ~ 13

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.

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Tinjauan sistematis: Efektifitas Palliative Home Care untuk Pasien dengan HIV/AIDS

Jurnal Keperawatan Padjadjaran ◽

10.24198/jkp.v5i1.347 ◽

1970 ◽

Vol 5 (1) ◽

Author(s):

Linlin Lindayani ◽

Nenden Nur Asriyani Maryam

Keyword(s):

Palliative Care ◽

Home Care ◽

Palliative Medicine ◽

Cochrane Library ◽

Palliative Home Care ◽

Hiv Aids

Asuhan palitif untuk pasien dengan HIV/AIDS merupakan elemen inti dari asuhan pasien dengan HIV/AIDS. Asuhan paliatif yang berbasis home care saat ini menjadi elemen penting yang digunakan di berbagainegara. Akan tetapi, tidak ada studi atau tinjauan sebelumnya yang menganalisis efektifitas dari asuhanpaliatif yang berbasis home care pada pasien dengan HIV/AIDS. Tujuan dari tinjauan sistematik ini adalahuntuk mengevaluasi efektivitas Palliative Home Care untuk pasien dengan HIV/AIDS terhadap nyeri,pengendalian gejala, meningkatkan kualitas hidup, meningkatkan kepuasan asuhan, dan efektivitas biaya.Pencarian awal terbatas dilakukan di MEDLINE dan CINAHL. Kedua database tersebut dipilih denganpertimbangan bahwa keduanya merupakan database terbesar di bidang kesehatan dan kedokteran. Kemudiastrategi pencarian lainnya dilakukan pada database lain meliputi: Cochrane Library, UpToDate, Ovid, AIDSCare, Journal of Palliative Care, dan Journal of Palliative Medicine. Studi yang diterbitkan dalam Bahasa Inggrisdan tahun 2000-2016 dipertimbangkan untuk dimasukkan dalam tinjauan ini. Data diekstrak oleh penulis dandiringkas menggunakan alat ekstraksi data dari JBI (Joanna Briggs Institute). Kami menemukan 4 studi yangmasuk kedalam kriteria tinjauan kami, satu studi randomizes control trial dan tiga studi prospectively control.Hasil dari tinjauan ini menunjukkan bahwa Palliative Home Care terbukti efektif dalam mengontol nyeridan gejala-gelaja lain, mempertahankan dan meningkatkan kualitas hidup pasien, tingginya kepuasan daripasien dan kelurga terhadap asuhan Palliative Home Care berkisar 93% - 96% dan lebih cost-effectivenessdibandingkan dengan Hospital-Based Palliative Care. Dengan demikian, penting untuk mengembangkanPalliative Home Care untuk pasien dengan HIV/AIDS terutama untuk negara dengan sumber daya yang terbatas.

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Patients Benefit from Using the Integrated Palliative Care Outcome Scale During Specialized Palliative Home Care

10.26226/morressier.5c76c8bbe2ea5a7237612610 ◽

2019 ◽

Author(s):

Ingela Beck

Keyword(s):

Palliative Care ◽

Home Care ◽

Palliative Home Care ◽

Palliative Care Outcome Scale ◽

Care Outcome

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Quality Assurance in Specialized Palliative Home Care (QUAPS) - A Questionnaire's Feasibility

10.26226/morressier.5c76c8bbe2ea5a72376125f5 ◽

2019 ◽

Author(s):

David Berghaus

Keyword(s):

Quality Assurance ◽

Home Care ◽

Palliative Home Care

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Faculty Opinions recommendation of Client, caregiver, and provider perspectives of safety in palliative home care: a mixed method design.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725776450.793509570 ◽

2015 ◽

Author(s):

Jeffrey Braithwaite ◽

Anne Hogden

Keyword(s):

Home Care ◽

Mixed Method ◽

Palliative Home Care ◽

Provider Perspectives ◽

Mixed Method Design

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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

Palliative Medicine ◽

10.1177/02692163211026516 ◽

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 .

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