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Palliative home care and emergency department visits in the last 30 and 90 days of life: a retrospective cohort study of patients with cancer
  1. Jennifer Mracek1,
  2. Madalene Earp2 and
  3. Aynharan Sinnarajah2,3
  1. 1University of Calgary, Calgary, Alberta, Canada
  2. 2Department of Oncology, University of Calgary, Calgary, Alberta, Canada
  3. 3Palliative & End of Life Care, Alberta Health Services, Calgary, Alberta, Canada
  1. Correspondence to Dr Aynharan Sinnarajah, Department of Oncology, University of Calgary, Calgary, Canada; aynharan.sinnarajah{at}ahs.ca

Abstract

Objectives Evaluate the association of specialist palliative home care (HC) on emergency department (ED) visits in the 30 and 90 days prior to death.

Methods This retrospective cohort study using administrative data identified 6976 adults deceased from cancer between 2008 and 2015, living ≥180 days after diagnosis of cancer, and residing in the urban Calgary Zone of Alberta Health Services. All palliative HC and generalist HC services were examined. Regression analyses examined the relationships of HC type to ED visits in the last 30 or 90 days of life.

Results In the last 30 days of life, compared with patients receiving palliative HC, patients receiving only generalist HC, or no HC, were more likely to visit the ED (OR)generalist-HC 1.19; 95% CI 1.06 to 1.34; ORno-HC 1.54; 95% CI 1.31 to 1.82). In the last 90 days of life, compared with patients receiving palliative HC, those receiving generalist HC (OR 1.48; 95% CI 1.32 to 1.67) and no HC (OR 1.66; 95% CI 1.39 to 1.99) had increased odds of visiting the ED.

Conclusions Receiving generalist HC and no HC was associated with increased odds of visiting the ED in the last 30 and 90 days of life, when compared with patients receiving palliative HC. Improving access to palliative HC for patients at high risk of visiting the ED may reduce ED visits and acute care costs and improve quality of life in the last 90 days of life.

  • Home care
  • Cancer
  • End of life care
  • Quality of life

Data availability statement

Data are available on reasonable request. The dataset from this study is held securely in coded form at the University of Calgary. While the conditions of our ethics approval prohibit making the dataset publicly available, access to anonymised summary-level (aggregate data) may be granted (conditional on permission from data custodian: Alberta Health Services) upon request by emailing aynharan.sinnarajah@ahs.ca. The full dataset creation plan and underlying analytic code are available from on request by emailing aynharan.sinnarajah@ahs.ca, understanding that the programmes may rely on coding templates or macros that are unique to Alberta Health Services and this study. The corresponding author (AS) affirms that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

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Data availability statement

Data are available on reasonable request. The dataset from this study is held securely in coded form at the University of Calgary. While the conditions of our ethics approval prohibit making the dataset publicly available, access to anonymised summary-level (aggregate data) may be granted (conditional on permission from data custodian: Alberta Health Services) upon request by emailing aynharan.sinnarajah@ahs.ca. The full dataset creation plan and underlying analytic code are available from on request by emailing aynharan.sinnarajah@ahs.ca, understanding that the programmes may rely on coding templates or macros that are unique to Alberta Health Services and this study. The corresponding author (AS) affirms that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

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Footnotes

  • Twitter @DrASinnarajah

  • Contributors JM, ME and AS contributed to the study concept and design. ME and AS were responsible for acquisition of data. JM, ME and AS were responsible for data processing and interpretation of the data. JM performed all statistical analyses and drafted the manuscript. ME and AS contributed to the critical revision of the manuscript for important intellectual content. AS obtained funding and is the guarantor. The corresponding author attests that all listed authors meet the authorship criteria and that no other authors meeting the criteria have been omitted.

  • Funding The analysis was supported by a research grant AS received from the M.S.I. foundation to perform this work.

  • Competing interests All authors declare: support from a research grant AS received from the M.S.I. foundation to perform this work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Patient and public involvement statement All patients were deceased, precluding involvement in the design, conduct, reporting or dissemination plans of our research. The public were not involved in the design, conduct, reporting or dissemination of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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