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

Spilsbury, Katrina; Rosenwax, Lorna; Arendts, Glenn; Semmens, James B.

doi:10.1371/journal.pone.0185275

Cited by 32 publications

(32 citation statements)

References 31 publications

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“…found an increase in non‐potentially avoidable GP type ED presentations when examining inappropriate ED presentations in patients over the age of 70 years, with most related to cardiovascular or respiratory illness . A recent Western Australian study demonstrated the receipt of palliative home care nursing significantly reduced the rate of both lower acuity and higher acuity ED presentations . Our study did not address appropriateness of presentation, although it is worth noting a high proportion of patients required hospital admission.…”

Section: Discussionmentioning

confidence: 67%

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Patients with life‐limiting illness presenting to the emergency department

Ragg

Milnes

et al. 2019

Emerg Medicine Australasia

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Objective To examine characteristics, outcomes and flow for patients over the age of 45 years with a life‐limiting illness (LLI) presenting to a regional ED. Methods Retrospective, observational cohort study of patients with LLI in an Australian regional ED over a 15‐day period. Eligible patients were 45 years of age or older who fulfilled criteria for having an LLI. Data included demographics, diagnosis for current presentation, presence of advance care documentation, LLI category, admission and discharge destination from ED, ED and hospital length of stay and outcome for patients admitted to the acute hospital. Results A total of 152 (12%) patients had an LLI. The LLI group were older, had a significantly longer median length of stay in the ED (5.9 [interquartile range 4.0–8.4] vs 3.9 h [interquartile range 2.5–6.3], P < 0.0001) and were less likely to leave the ED within 4 h (26% vs 51.5%, P < 0.0001). Forty‐six percent of patients with an LLI had some form of advanced care documentation. Patients with an LLI were more likely to require hospital admission. In relation to illness trajectory, the frailty/dementia trajectory group had comparatively the longest ED length of stay with less than 10% leaving the ED within 4 h. This group were more likely to be discharged to a residential care facility. Conclusion A significant proportion of patients 45 years or older had an LLI which had implications for their length of ED stay and discharge destination.

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Section: Discussionmentioning

confidence: 67%

“…14 A recent Western Australian study demonstrated the receipt of palliative home care nursing significantly reduced the rate of both lower acuity and higher acuity ED presentations. 15 Our study did not address appropriateness of presentation, although it is worth noting a high proportion of patients required hospital admission.…”

Section: Discussionmentioning

confidence: 93%

Patients with life‐limiting illness presenting to the emergency department

Ragg

Milnes

et al. 2019

Emerg Medicine Australasia

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“…At hospital discharge, patients may be referred to community‐based palliative services (including nursing or multidisciplinary specialist teams), hospital outpatient clinics, a palliative care unit or hospice. Multidisciplinary and other community‐based palliative care services can reduce hospital use and tend to be accessed earlier than hospital‐based care . These services, as well as residential aged care facilities, may have provided care to our decedents during their last year and/or final days of life, but any care they provided and its subsequent impact on hospital use could not be assessed by the data available for our study.…”

Section: Discussionmentioning

confidence: 97%

Inpatient palliative care of people dying in New South Wales hospitals or soon after discharge

Stubbs

Assareh

Achat

et al. 2019

Internal Medicine Journal

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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%

“…Two studies found no change in visits to the emergency department between intervention and control groups [52,54]. Duration of hospital stay appeared to be shorter when patients were enrolled in one of the initiatives under examination [40,43,49,51,52], and fewer of those patients died in hospital [41,43,46,[49][50][51].…”

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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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

Cited by 32 publications

References 31 publications

Patients with life‐limiting illness presenting to the emergency department

Patients with life‐limiting illness presenting to the emergency department

Inpatient palliative care of people dying in New South Wales hospitals or soon after discharge

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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