Do community hospice programmes reduce hospitalisation rate in patients with advanced chronic obstructive pulmonary disease?

Iupati, Salina; Ensor, Brian

doi:10.1111/imj.12947

Cited by 15 publications

(24 citation statements)

References 27 publications

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“…While a reduction in acute care service use has been consistently reported for end of life patients who receive community (home) care, both in Australia 19, 29 and internationally [7][8][9]30 , it is encouraging to report here that the association with reduced ED use was similar for all of the five different underlying cause of death conditions, gender and living arrangements.…”

Section: Discussionsupporting

confidence: 61%

“…[1][2][3][4] Numerous studies have reported community (home)-based palliative care in people with life limiting conditions is associated with reduced use of acute care health services. [5][6][7][8][9] While multidisciplinary palliative care has been demonstrated to reduce acute care service use, not all use of ED is unwarranted. A study of cancer patients receiving outpatient palliative care in the United States reported 77% of ED visits were unavoidable.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Association of Community-Based Palliative Care With Reduced Emergency Department Visits in the Last Year of Life Varies by Patient Factors

Spilsbury

Rosenwax

Arendts

et al. 2017

Annals of Emergency Medicine

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Section: Discussionsupporting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

The Association of Community-Based Palliative Care With Reduced Emergency Department Visits in the Last Year of Life Varies by Patient Factors

Spilsbury

Rosenwax

Arendts

et al. 2017

Annals of Emergency Medicine

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“…A New Zealand study showed a one-year hospice programme was associated with a reduction in hospital admissions for COPD patients. [ 8 ] An Italian study reported home-based care reduced prolonged stays in hospital in the last month of life for non-cancer deaths, however decedents older than 85 years, living in a nursing home or who were not hospitalised in the last year of life were excluded, thus limiting the generalisation of findings. [ 7 ] A US based study found less hospital use in the last months of life in patients with cancer, COPD, dementia and heart failure who had received structured home-based palliative care.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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ObjectiveCommunity-based palliative care is known to be associated with reduced acute care health service use. Our objective was to investigate how reduced acute care hospital use in the last year of life varied temporally and by patient factors.MethodsA retrospective cohort study of the last year of life of 12,763 Western Australians who died from cancer or one of seven non-cancer conditions. Outcome measures were rates of hospital admissions and mean length of hospital stays. Multivariate analyses involved time-to-event and population averaged log-link gamma models.ResultsThere were 28,939 acute care overnight hospital admissions recorded in the last year of life, an average of 2.3 (SD 2.2) per decedent and a mean length of stay of 9.2 (SD 10.3) days. Overall, the rate of hospital admissions was reduced 34% (95%CI 1–66) and the mean length of stay reduced 6% (95%CI 2–10) during periods of time decedents received community-based palliative care compared to periods of time not receiving this care. Decedents aged <70 years receiving community-based palliative care showed a reduced rate of hospital admission around five months before death, whereas for older decedents the reduction in hospital admissions was apparent a year before death. All decedents who were receiving community-based palliative care tended towards shorter hospital stays in the last month of life. Decedents with neoplasms had a mean length of stay three weeks prior to death while not receiving community-based palliative care of 9.6 (95%CI 9.3–9.9) days compared to 8.2 (95% CI 7.9–8.7) days when receiving community-based palliative care.ConclusionRates of hospital admission during periods of receiving community-based palliative care were reduced with benefits evident five months before death and even earlier for older decedents. The mean length of hospital stay was also reduced while receiving community-based palliative care, mostly in the last month of life.

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“…[ [38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55] 2c; 24/7 helpline Support for patients, carers, paramedics and non-specialist doctors and nurses. [27,39,46,48,56] 2d; Telehealth/ telecaring Provision of healthcare remotely using telecommunication technology.…”

Section: Part 2 Overviewmentioning

confidence: 99%

“…A proportion of studies concentrated on a specific disease area, including cancer [41,43,46,47,50,51], chronic obstructive pulmonary disease [44], dementia [45] and heart failure [38]. The others included mixed diagnoses.…”

Section: B; Palliative Care Support In the Communitymentioning

confidence: 99%

A scoping review of initiatives to reduce inappropriate or non-beneficial hospital admissions and bed days in people nearing the end of their life: much innovation, but limited supporting evidence

et al. 2020

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Background: Hospitalisation during the last weeks of life when there is no medical need or desire to be there is distressing and expensive. This study sought palliative care initiatives which may avoid or shorten hospital stay at the end of life and analysed their success in terms reducing bed days. Methods: Part 1 included a search of literature in PubMed and Google Scholar between 2013 and 2018, an examination of governmental and organisational publications plus discussions with external and co-author experts regarding other sources. This initial sweep sought to identify and categorise relevant palliative care initiatives. In Part 2, we looked for publications providing data on hospital admissions and bed days for each category. Results: A total of 1252 abstracts were reviewed, resulting in ten broad classes being identified. Further screening revealed 50 relevant publications describing a range of multi-component initiatives. Studies were generally small and retrospective. Most researchers claim their service delivered benefits. In descending frequency, benefits identified were support in the community, integrated care, out-of-hours telephone advice, care home education and telemedicine. Nurses and hospices were central to many initiatives. Barriers and factors underpinning success were rarely addressed. Conclusions: A wide range of initiatives have been introduced to improve end-of-life experiences. Formal evidence supporting their effectiveness in reducing inappropriate/non-beneficial hospital bed days was generally limited or absent.

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Do community hospice programmes reduce hospitalisation rate in patients with advanced chronic obstructive pulmonary disease?

Abstract: Community hospice programmes may be associated with reduction in hospitalisation in patients with advanced COPD.

Cited by 15 publications

References 27 publications

The Association of Community-Based Palliative Care With Reduced Emergency Department Visits in the Last Year of Life Varies by Patient Factors

The Association of Community-Based Palliative Care With Reduced Emergency Department Visits in the Last Year of Life Varies by Patient Factors

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

A scoping review of initiatives to reduce inappropriate or non-beneficial hospital admissions and bed days in people nearing the end of their life: much innovation, but limited supporting evidence

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