title: Transmural care. A new approach in the care for terminal cancer patients: its effects on re-hospitalization and quality of life.
abstract: Despite their wishes, terminal cancer patients are frequently readmitted to hospitals. This appears in part to be due to poor communication amongst professional caregivers and/or the overburdening of their (informal) caregivers. This quasi-experimental study investigated the effects of a transmural home care programme on re-hospitalization, quality of life and place of death for terminal cancer patients. The programme intended to optimize communication, cooperation and coordination between intra- and extra-mural health care organizations (transmural care). Initial patient characteristics of the intervention group (n = 79) matched those of the control group (n = 37) well. When compared to the control group, which received the standard community care, patients in the intervention group underwent significantly less re-hospitalization during the terminal phase of their illness (5.8 versus 11.5 days; P < 0.01) while the intervention contributed significantly positive to the patients' "physical" quality of life 1 month after the start of the intervention. A higher, but not significant (P = 0.06) percentage of patients in the intervention group also died at home (81 versus 65%). The introduction of measures to enhance coordination and cooperation of intra- and extramural care, seems to be an improvement compared to standard community care.
authors.affiliation: Department of Multidisciplinary Oncology, Catharina Hospital, Eindhoven, The Netherlands. fsk@iaehv.nl
authors.forename: F W
authors.initials: FW
authors.lastname: Smeenk
authors.forename: L P
authors.initials: LP
authors.lastname: de Witte
authors.forename: J C
authors.initials: JC
authors.lastname: van Haastregt
authors.forename: R M
authors.initials: RM
authors.lastname: Schipper
authors.forename: H P
authors.initials: HP
authors.lastname: Biezemans
authors.forename: H F
authors.initials: HF
authors.lastname: Crebolder
mesh_terms: D000368:Aged; D003152:Community Health Nursing / Q000458:organization & administration; D003266:Continuity of Patient Care / Q000458:organization & administration; D005260:Female; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology / Q000628:therapy*; D009426:Netherlands; D010359:Patient Readmission / Q000706:statistics & numerical data*; D015397:Program Evaluation; D011788:Quality of Life; D013727:Terminal Care / Q000458:organization & administration*