Abstract

Background: In Canada, approximately one in two decedents die in acute care settings. This is not only costly to the health care system but also considered to be a marker of poor quality care for patients at the end of life. One factor that can influence a patient’s place of death is the provision of community-based home care near the end of life, particularly if delivered with palliative intent. Unfortunately, not all decedents will receive palliative home care prior to death. As such, to our knowledge, a gap in the literature exists for a population-level study assessing the prevalence of general (i.e., non-palliative) versus palliative-intent home care delivered to decedents at the end of life, and what impact (if any) the two different types of home care packages has on decedents’ places of death and overall total cost of care.

Objective: To describe and understand the impact of non-palliative versus palliative-intent home care services on the place of death and health care cost in the last three months of life.

Methods: This is a retrospective cohort study using routinely-collected data recording health care services delivered under the publicly-funded health care system in Ontario, Canada. We included all decedents in Ontario who died between April 1, 2011 and March 31, 2015 for this study (n=277,128). Regression analyses examined the relationship between receipt of home care and place of death, as well as total health care cost.

Results: In the last three months of life, decedents who received end-of-life care were significantly less likely to die in an acute care setting (OR = 0.248, p<0.001) and had lower total health care cost (OR = 0.935, p <0.001) than those who did not receive home care. Palliative visits by nurse practitioners demonstrated the largest effect on reducing the risk of acute care deaths (OR=0.948, p<0.001) and health care cost (OR= 0.982, p<0.001). Conclusions: Decedents who received home care with palliative intent, and those who received home care from palliative care nurse practitioners, were significantly less likely to die in an acute care setting and have lower total health care cost.