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Earlier Initiation of Community-Based Palliative Care Is Associated With Fewer Unplanned Hospitalizations and Emergency Department Presentations in the Final Months of Life: A Population-Based Study Among Cancer Decedents

Wright, CM, Youens, D and Moorin, RE 2018 , 'Earlier Initiation of Community-Based Palliative Care Is Associated With Fewer Unplanned Hospitalizations and Emergency Department Presentations in the Final Months of Life: A Population-Based Study Among Cancer Decedents' , Journal of pain and symptom management, vol. 55, no. 3 , pp. 745-754 , doi: 10.1016/j.jpainsymman.2017.11.021.

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Abstract

Context: Although community-based palliative care (CPC) is associated with decreased acute care use in the lead up todeath, it is unclear how the timing of CPC initiation affects this association.Objectives: We aimed to explore the association between timing of CPC initiation and hospital use, over the final one,three, six, and 12 months of life.Methods: We conducted a retrospective, population-based study in Perth, Western Australia. Linked administrative dataincluding cancer registry, mortality, hospital admissions, emergency department (ED), and CPC records were obtained forcancer decedents from 1 January, 2001 to 31 December, 2011. The exposure was month of CPC initiation; outcomes wereunplanned hospitalizations, ED presentations, and associated costs.Results: Of 28,331 decedents residing in the CPC catchment area, 16,439 (58%) accessed CPC, mostly (64%) in the lastthree months of life. Initiation of CPC before the last six months of life was associated with a lower mean rate of unplannedhospitalizations in the last six months of life (1.4 vs. 1.7 for initiation within six months of death); associated costs were alsolower ($(A2012) 12,976 vs. $13,959, comparing the same groups). However, those initiating CPC earlier did show a trendtoward longer time in hospital when admitted, compared to those initiating in the final month of life.Conclusions: When viewed at a population level, these results argue against temporally restricting access to CPC, as earlierinitiationmay pay dividends in the final fewmonths of life in terms of fewer unplanned hospitalizations and ED presentations.

Item Type: Article
Authors/Creators:Wright, CM and Youens, D and Moorin, RE
Keywords: Palliative care, hospital costs, community health services, linked administrative data
Journal or Publication Title: Journal of pain and symptom management
Publisher: Elsevier Science Inc
ISSN: 0885-3924
DOI / ID Number: 10.1016/j.jpainsymman.2017.11.021
Copyright Information:

Copyright 2017 American Academy of Hospice and Palliative Medicine

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