Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jan 21;9(1):e025180.
doi: 10.1136/bmjopen-2018-025180.

Impact of palliative home care support on the quality and costs of care at the end of life: a population-level matched cohort study

Arno Maetens  1 , Kim Beernaert  1 , Robrecht De Schreye  1 , Kristof Faes  1   2 , Lieven Annemans  2 , Koen Pardon  1 , Luc Deliens  1   3 , Joachim Cohen  1
Affiliations

Impact of palliative home care support on the quality and costs of care at the end of life: a population-level matched cohort study

Arno Maetens et al. BMJ Open. .

Abstract

Objectives: To evaluate the impact of palliative home care support on the quality of care and costs in the last 14 days of life.

Design: Matched cohort study using linked administrative databases.

Setting: All people who died in Belgium in 2012 (n=107 847).

Participants: 8837 people who received palliative home care support in the last 720 to 15 days of life matched 1:1 by propensity score to 8837 people who received usual care.

Intervention: Receiving the allowance for palliative home patients, multidisciplinary palliative home care team visit or palliative nurse or physiotherapist visit at home.

Main outcome measures: Home death, number of family physician contacts, number of primary caregiver contacts, hospital death, hospital admission, intensive care unit (ICU) admission, emergency department (ED) admission, diagnostic testing, blood transfusion and surgery. Total inpatient and outpatient costs. All outcomes were measured in the last 14 days of life.

Results: In the unmatched cohort, 11 149 (13.5%) people received palliative home care support in the last 720 to 15 days of life. After matching, those using palliative home care support had, compared with those who did not, more family physician contacts (mean 3.1 [SD=6.5] vs 0.8 [SD=1.2]), more chance of home death (56.2%vs13.8%; relative risk [RR]=4.08, 95% CI 3.86 to 4.31), lower risk of hospital admission (27.4%vs60.8%; RR=0.45, 95% CI 0.43 to 0.46), ICU admission (18.3%vs40.4%; RR=0.45, 95% CI 0.43 to 0.48) or ED admission (15.2%vs28.1%; RR=0.54, 95% CI 0.51 to 0.57). Mean total costs of care were lower for those using palliative home care support (€3081 [95% CI €3025 to €3136] vs €4698 [95% CI €4610 to €4787]; incremental cost: -€1617 [p<0.001]).

Conclusions: Palliative home care support use positively impacts quality of care and reduces total costs of care at the end of life in Belgium. Policy makers and healthcare practitioners should increasingly focus on communicating the existing options for palliative home care support to patients and their caregivers.

Keywords: health Policy; health economics; palliative care; quality In health care.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow chart of the study population selection.
See this image and copyright information in PMC

References

    1. Higginson IJ, Sen-Gupta GJ. Place of care in advanced cancer: a qualitative systematic literature review of patient preferences. J Palliat Med 2000;3:287–300. 10.1089/jpm.2000.3.287 - DOI - PubMed
    1. Connor S, Bermedo M. Global atlas of palliative care at the end of life. 2014. http://www.who.int/cancer/publications/palliative-care-atlas/en/ (Accessed 9 Oct 2015).
    1. Murtagh F. Can palliative care teams relieve some of the pressure on acute services? BMJ 2014;348:g3693 10.1136/bmj.g3693 - DOI - PubMed
    1. Morin L, Aubry R, Frova L, et al. Estimating the need for palliative care at the population level: a cross-national study in 12 countries. Palliat Med 2017;31:526–36. 10.1177/0269216316671280 - DOI - PubMed
    1. Palliative care. The solid facts. 2004. http://www.euro.who.int/en/health-topics/environment-and-health/urban-he... (Accessed 14 Apr 2017).

Publication types