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. 2024 Feb 25;196(7):E209-E221.
doi: 10.1503/cmaj.221513.

Estimated mortality risk and use of palliative care services among home care clients during the last 6 months of life: a retrospective cohort study

Maya Murmann  1 , Douglas G Manuel  1 , Peter Tanuseputro  1 , Carol Bennett  1 , Michael Pugliese  1 , Wenshan Li  1 , Rhiannon Roberts  1 , Amy T Hsu  2
Affiliations

Estimated mortality risk and use of palliative care services among home care clients during the last 6 months of life: a retrospective cohort study

Maya Murmann et al. CMAJ. .

Abstract

Background: In Canada, only 15% of patients requiring palliative care receive such services in the year before death. We describe health care utilization patterns among home care users in their last 6 months of life to inform care planning for older people with varying mortality risks and evolving care needs as they decline.

Methods: Using population health administrative data from Ontario, we performed a retrospective cohort study involving home care clients aged 50 years and older who received at least 1 interRAI (Resident Assessment Instrument) Home Care assessment between April 2018 and September 2019. We report the proportion of clients who used acute care, long-term care, and palliative home care services within 6 months of their assessment, stratified by their predicted 6-month mortality risk using a prognostic tool called the Risk Evaluation for Support: Predictions for Elder-life in their Communities Tool (RESPECT) and vital status.

Results: The cohort included 247 377 adults, 11.9% of whom died within 6 months of an assessment. Among decedents, 50.6% of those with a RESPECT-estimated median survival of fewer than 3 months received at least 1 nonphysician palliative home care visit before death. This proportion declined to 38.7% and 29.5% among decedents with an estimated median survival between 3 and 6 months and between 6 and 12 months, respectively.

Interpretation: Many older adults in Ontario do not receive any palliative home care before death. Prognostic tools such as RESPECT may improve recognition of reduced life expectancies and palliative care needs of individuals in their final years of life.

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Conflict of interest statement

Competing interests: Amy Hsu is an executive lead on the steering committee of the Ontario Centres for Learning, Research, and Innovation in Long-Term Care. Funding for the centres comes from the Ontario Ministry of Health and Ministry of Long-Term Care and is partially administered by the Bruyère Research Institute. No other competing interests were declared.

Figures

Figure 1:
Figure 1:
Proportion of decedents with at least 1 palliative home care visit provided by a nonphysician and distribution of the number of visits within 6 months of an interRAI Home Care assessment, as illustrated by the box and whisker plots. The lower and upper boundaries of the boxes represent the first and third quartile values. The boundaries between the darker and lighter shaded areas represent the median value. The “whiskers” extending from the top and bottom of the boxes represent the 95% confidence intervals. Note: interRAI = Resident Assessment Instrument, RESPECT = Risk Evaluation for Support: Predictions for Elder-life in their Communities Tool.
Figure 2:
Figure 2:
Proportion of decedents with at least 1 palliative home care visit provided by a physician and distribution of the number of visits within 6 months of an interRAI Home Care assessment, as illustrated by the box and whisker plots. The lower and upper boundaries of the boxes represent the first and third quartile values. The boundaries between the darker and lighter shaded areas represent the median value. The “whiskers” extending from the top and bottom of the boxes represent the 95% confidence intervals. Note: interRAI = Resident Assessment Instrument, RESPECT = Risk Evaluation for Support: Predictions for Elder-life in their Communities Tool.
Figure 3:
Figure 3:
Proportion of decedents having at least 1 day with an emergency department visit and distribution of the number of days within 6 months of an interRAI Home Care assessment where at least 1 emergency department visit had occurred. The distributions are illustrated by box and whisker plots. The lower and upper boundaries of the boxes represent the first and third quartile values. The boundaries between the darker and lighter shaded areas represent the median value. The “whiskers” extending from the top and bottom of the boxes represent the 95% confidence intervals. Note: ED = emergency department, interRAI = Resident Assessment Instrument, RESPECT = Risk Evaluation for Support: Predictions for Elder-life in their Communities Tool.
Figure 4:
Figure 4:
Proportion of decedents with at least 1 acute care hospital admission and distribution of hospital admission days within 6 months of an interRAI Home Care assessment, as illustrated by the box and whisker plots. The lower and upper boundaries of the boxes represent the first and third quartile values. The boundaries between the darker and lighter shaded areas represent the median value. The “whiskers” extending from the top and bottom of the boxes represent the 95% confidence intervals. Note: interRAI = Resident Assessment Instrument, RESPECT = Risk Evaluation for Support: Predictions for Elder-life in their Communities Tool.
Figure 5:
Figure 5:
Proportion of decedents admitted to a long-term care facility and distribution of days in long-term care within 6 months of an interRAI Home Care assessment, as illustrated by the box and whisker plots. The lower and upper boundaries of the boxes represent the first and third quartile values. The boundaries between the darker and lighter shaded areas represent the median value. The “whiskers” extending from the top and bottom of the boxes represent the 95% confidence intervals. Note: interRAI = Resident Assessment Instrument, LTC = long-term care, RESPECT = Risk Evaluation for Support: Predictions for Elder-life in their Communities Tool.
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References

    1. Senderovich H, McFadyen K. Palliative care: Too good to be true? Rambam Maimonides Med J 2020;11:e0034. - PMC - PubMed
    1. Meier DE, McCormick E. Benefits, services, and models of subspecialty palliative care. Waltham (MA): UpToDate; 2020. Available: https://www.uptodate.com/contents/benefits-services-and-models-of-subspe... (accessed 2023 Jan. 12).
    1. Sepúlveda C, Marlin A, Yoshida T, et al. . Palliative care: the World Health Organization’s global perspective. J Pain Symptom Manage 2002;24:91–6. - PubMed
    1. Hamel L, Wu B, Brodie M. Views and experiences with end-of-life medical care in the U.S. Menlo Park (CA): The Henry J. Kaiser Family Foundation; 2017:21. Available: https://files.kff.org/attachment/Report-Views-and-Experiences-with-End-o... (accessed 2023 Jan. 12).
    1. Palliative care facts and stats. New York: Center to Advance Palliative Care; 2014. Available: https://media.capc.org/filer_public/68/bc/68bc93c7-14ad-4741-9830-869172... (accessed 2023 Jan. 12).