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Does Continuous Hospice Care Help Patients Remain at Home?
David Casarett1, Joan Harrold2, Pamela S Harris3
1Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Journal of Pain and Symptom Management
|May 5, 2015
Summary
Continuous hospice care at home significantly reduces inpatient deaths, especially when a spouse provides care. This finding highlights the benefit of intensive home support for terminally ill patients.
Area of Science:
- Palliative Care
- Gerontology
- Health Services Research
Background:
- Hospice care in the U.S. sometimes includes high-intensity "continuous care" provided in patients' homes.
- Limited data exist on the utilization and patient outcome impacts of continuous care.
Purpose of the Study:
- To characterize patients receiving continuous care.
- To evaluate if continuous care decreases the likelihood of death in an inpatient or hospital setting.
Main Methods:
- Analysis of electronic medical records from 147,137 patients across 11 U.S. hospices (2008-2012).
- Utilized a propensity score-matched cohort design for comparative analysis.
- Compared outcomes for patients receiving continuous care versus routine care on the day before death.
Main Results:
- Of patients dying at home or in nursing homes, 10.2% received continuous care.
- Continuous care was associated with a significant reduction in inpatient deaths (4.1% vs. 12.6%).
- Caregiver type influenced outcomes: spouse-provided care showed a greater reduction in inpatient deaths with continuous care.
Conclusions:
- Continuous care use on the day before death significantly decreases inpatient care utilization.
- The reduction in inpatient deaths is particularly pronounced when continuous care is provided to patients with spousal caregivers.
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