Article Text
Abstract
Objectives To evaluate the impact of palliative home care support on the quality of care and costs in the last 14 days of life.
Design Matched cohort study using linked administrative databases.
Setting All people who died in Belgium in 2012 (n=107 847).
Participants 8837 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.
Intervention Receiving the allowance for palliative home patients, multidisciplinary palliative home care team visit or palliative nurse or physiotherapist visit at home.
Main outcome measures Home 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.
Results In 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]).
Conclusions Palliative 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.
- palliative care
- quality In health care
- health Policy
- health economics
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Footnotes
Patient consent for publication Not required.
Contributors The lead author affirms that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained. AM, KB, JC and LD contributed to the conception and design of the article. Collection, analysis and interpretation of data were done by all authors. AM wrote the manuscript. The final approval of the manuscript was done by KB, RDS, KF, LA, KP, LD and JC.
Funding This study is supported by a grant from the Flemish government agency for Innovation by Science and Technology (Agentschap voor Innovatie door Wetenschap en Technologie; SBO IWT nr. 140009).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement In accordance with Belgian law, approvals for access to the various databases and the database integrating all databases were obtained from two separate national sectoral committees for privacy protection. Due to ethical concerns with regard to sensitive and potentially identifying data, the supporting data cannot be made openly available, as stated by the Sectoral Committee of Social Security and Health – Department Health and the Data Protection Authority. Both are subcommittees of the Belgian Commission for the Protection of Privacy. Additionally, the ethics committee of the Ghent University Hospital provided approval (B670201422382). Further information about the data and access regulations are available on request.