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Comparative Study
. 2017 Mar;31(3):247-257.
doi: 10.1177/0269216316653524. Epub 2016 Jul 10.

Palliative care delivery across health sectors: A population-level observational study

Peter Tanuseputro  1   2 , Suman Budhwani  3 , Yu Qing Bai  3 , Walter P Wodchis  3   4
Affiliations
Comparative Study

Palliative care delivery across health sectors: A population-level observational study

Peter Tanuseputro et al. Palliat Med. 2017 Mar.

Abstract

Background: Little population-level information exists about the delivery of palliative care across multiple health sectors, important in providing a complete picture of current care and gaps in care.

Aim: Provide a population perspective on end-of-life palliative care delivery across health sectors.

Design: Retrospective population-level cohort study, describing palliative care in the last year of life using linked health administrative databases.

Setting/participants: All decedents in Ontario, Canada, from 1 April 2010 to 31 March 2012 ( n = 177,817).

Results: Across all health sectors, about half (51.9%) of all decedents received at least one record of palliative care in the last year of life. Being female, middle-aged, living in wealthier and urban neighborhoods, having cancer, and less multi-morbidity were all associated with higher odds of palliative care receipt. Among 92,276 decedents receiving palliative care, 84.9% received care in acute care hospitals. Among recipients, 35 mean days of palliative care were delivered. About half (49.1%) of all palliative care days were delivered in the last 2 months of life, and half (50.1%) had palliative care initiated in this period. Only about one-fifth of all decedents (19.3%) received end-of-life care through publicly funded home care. Less than 10% of decedents had a record of a palliative care home visit from a physician.

Conclusion: We describe methods to capture palliative care using administrative data. Despite an estimate of overall reach (51.9%) that is higher than previous estimates, we have shown that palliative care is infrequently delivered particularly in community settings and to non-cancer patients and occurs close to death.

Keywords: Palliative care; cancer; end-of-life care; home care services; house calls; palliative medicine.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Number of days of palliative care delivered by month prior to death for: all sectors, community-based palliative care (outpatient physician visits, home care, long-term care), and hospital-based palliative care (inpatient care in hospital, complex continuing care, and emergency room visits).
See this image and copyright information in PMC

References

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