The association between in-patient death, utilization of hospital resources and availability of palliative home care for cancer patients

Abstract

Background: The impact of palliative home care programs on in-patient admissions and deaths has not been appropriately established. Aim: The main objectives of this study have been to evaluate the frequency of in-patient hospital deaths and the use of hospital resources among cancer patients in two areas of the Madrid Region, as well as to assess differences between one area with and one without a palliative home care team (PHCT) in those variables. Design and setting: We conducted a population-based study comparing two adjacent metropolitan areas of approximately 200,000 inhabitants each in the Madrid Region, Spain, measuring in-patient deaths, emergency room admissions and in-patient days among cancer patients who died in 2005. Only one of the two areas had a fully established PHCT. Results: 524/549 cancer patients (95%) had an identified place of death: 74% died in hospital, 17% at home, 6% in an in-patient hospice and 3% in a nursing home. The frequency of hospital deaths was significantly lower among patients of the PHCT area (61% versus 77%, p < 0.001), as well as the number of patients using emergency and in-patient services (68% versus 79%, p = 0.004, and 66 versus 76%, p = 0.012, respectively). After adjusting for other factors, the risk of hospital death was lower among patients older than 80 (OR, 95% CI, 0.3, 0.1–0.5), higher among patients with hematological malignancies (OR 6.1, 2.0–18.9) and lower among patients of the PHCT area (OR 0.4, 0.2–0.6). Conclusions: Our findings suggest that a PHCT is associated with reduced in-patient deaths and overall hospitalization over the last two months of life.