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Avoiding costly hospitalisation at end of life: findings from a specialist palliative care pilot in residential care for older adults
  1. Michael Chapman1,2,
  2. Nikki Johnston3,
  3. Clare Lovell3,
  4. Liz Forbat4 and
  5. Wai-Man Liu5
  1. 1Department of Palliative Care, Canberra Regional Cancer Centre, Canberra Hospital, Canberra, Australian Capital Territory, Australia
  2. 2Australian National University Medical School, Canberra, Australian Capital Territory, Australia
  3. 3Clare Holland House, Calvary Health Care ACT, Canberra, Australian Capital Territory, Australia
  4. 4Director for the Calvary Centre for Palliative Care Research, Calvary Health Care Bruce and the Australian Catholic University, Canberra, Australian Capital Territory, Australia
  5. 5Research School of Finance, Actuarial Studies & Statistics, Australian National University, Canberra, Australian Capital Territory, Australia
  1. Correspondence to Dr Michael Chapman, Clare Holland House, Calvary Health Care ACT, C/O Clare Holland House 5 Menindee Dr Barton, Canberra, ACT 2600, Australia; mchapmanonline{at}


Objectives Specialist palliative care is not a standardised component of service delivery in nursing home care in Australia. Specialist palliative care services can increase rates of advance care planning, decrease hospital admissions and improve symptom management in such facilities. New approaches are required to support nursing home residents in avoiding unnecessary hospitalisation and improving rates of dying in documented preferred place of death. This study examined whether the addition of a proactive model of specialist palliative care reduced resident transfer to the acute care setting, and achieved a reduction in hospital deaths.

Methods A quasi-experimental design was adopted, with participants at 4 residential care facilities. The intervention involved a palliative care nurse practitioner leading ‘Palliative Care Needs Rounds’ to support clinical decision-making, education and training. Participants were matched with historical decedents using propensity scores based on age, sex, primary diagnosis, comorbidities and the Aged Care Funding Instrument rating. Outcome measures included participants’ hospitalisation in the past 3 months of life and the location of death.

Results The data demonstrate that the intervention is associated with a substantial reduction in the length of hospital stays and a lower incidence of death in the acute care setting. While rates of hospitalisation were unchanged on average, length of admission was reduced by an average of 3.22 days (p<0.01 and 95% CI −5.05 to −1.41), a 67% decrease in admitted days.

Conclusions The findings have significant implications for promoting quality outcomes through models of palliative care service delivery in residential facilities.

  • Supportive care
  • Nursing Home care
  • Clinical decisions
  • Education and training

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