Community Palliative Care Initiatives to Reduce End-of-Life Hospital Utilization and In-Hospital Deaths: A...

Area of Science:

• Palliative Care
• Health Services Research
• Gerontology

Background:

• End-of-life care often involves increased hospital use, contrary to patient wishes for home-based care.
• Palliative home care patients frequently experience high hospital utilization.

Purpose of the Study:

• To assess the impact of the Yellow Folder (home death planning) and Symptom Response Kit (home symptom management) on place of death.
• To evaluate the effect of these interventions on hospital utilization in palliative home care.

Main Methods:

• Ecologic, retrospective cohort study (April 2009-March 2014) in southeastern Ontario.
• Utilized linked health administrative and clinical databases.
• Regression analyses examined outcomes based on intervention receipt.

Main Results:

• Community deaths increased from 42.8% to 48.5% post-intervention (P < 0.0001).
• Patients receiving the Yellow Folder or Symptom Response Kit were more likely to die at home; combined use yielded the highest relative risk (RR=2.20).
• Interventions showed reduced hospitalization/ED visit rates only in the six months prior to death.

Conclusions:

• The Yellow Folder and Symptom Response Kit interventions promote remaining at home for end-of-life care.
• Combined use of these interventions demonstrated a stronger association with home deaths.