Regional Collaboration with Home Care Physicians is Associated with a Lower Proportion of In-hospital Deaths in...

Background　Although approximately 70% of the Japanese population would prefer to die at home, the actual in-hospital death rate in Japan is 71%. We previously reported that 71% of patients undergoing peritoneal dialysis (PD) died in the hospital (three centers, n=94). In this study, we examined how the place and cause of death among PD patients have changed since our previous report, as a result of strengthening our local collaboration with home care physicians at our institution.Methods　This single-center, retrospective observational study defined January 2008-June 2022 as the early period and July 2022-December 2024 as the late period of the study. The primary outcome was the place of death, and the secondary outcome was the cause of death. Statistical analyses included Fisher's exact test, Mann-Whitney U test, and logistic regression.Results　A total of 56 patients in the early period and 26 patients in the late period died while receiving PD. The in-hospital death rate decreased from 73% in the early period to 46% in the late period (p=0.03). In a multivariable analysis, collaboration with home-care physicians was independently associated with out-of-hospital death (adjusted odds ratio, 24.5; 95% confidence interval, 3.68-164; p＜0.01). Regarding the causes of out-of-hospital death, cardiovascular deaths tended to decrease from 80% to 43% (p=0.060), whereas changes in senility/cachexia and malignancy deaths were not significant (20% to 50%, p=0.128).Conclusions　Strengthening regional collaboration with home care physicians may be associated with a lower proportion of in-hospital deaths and it may facilitate home-based end-of-life care among PD patients. To improve the quality of death in patients undergoing PD, it is important to promote collaboration with home-care physicians and advance care planning and iterative shared decision-making (2nd SDM), including the transition from hemodialysis to PD.