title: Can the introduction of an integrated service model to an existing comprehensive palliative care service impact emergency department visits among enrolled patients?
abstract: OBJECTIVE
  Fewer emergency department (ED) visits may be a potential indicator of quality of care during the end of life. Receipt of palliative care, such as that offered by the adult Palliative Care Service (PCS) in Halifax, Nova Scotia, is associated with reduced ED visits. In June 2004, an integrated service model was introduced into the Halifax PCS with the objective of improving outcomes and enhancing care provider coordination and communication. The purpose of this study was to explore temporal trends in ED visits among PCS patients before and after integrated service model implementation.
  
  
  METHODS
  PCS and ED visit data were utilized in this secondary data analysis. Subjects included all adult patients enrolled in the Halifax PCS between January 1, 1999 and December 31, 2005, who had died during this period (N = 3221). Temporal trends in ED utilization were evaluated dichotomously as preintegration or postintegration of the new service model and across 6-month time blocks. Adjustments for patient characteristics were performed using multivariate logistic regression.
  
  
  RESULTS
  Fewer patients (29%) made at least one ED visit postintegration compared to the preintegration time period (36%, p < 0.001). Following adjustments, PCS patients enrolled postintegration were 20% less likely to have made at least one ED visit than those enrolled preintegration (adjusted OR 0.8; 95% confidence interval 0.6-1.0).
  
  
  CONCLUSIONS
  There is some evidence to suggest the introduction of the integrated service model has resulted in a decline in ED visits among PCS patients. Further research is needed to evaluate whether the observed reduction persists.
authors.affiliation: Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Beverley J
authors.initials: BJ
authors.lastname: Lawson
authors.forename: Frederick I
authors.initials: FI
authors.lastname: Burge
authors.forename: Paul
authors.initials: P
authors.lastname: McIntyre
authors.forename: Simon
authors.initials: S
authors.lastname: Field
authors.forename: David
authors.initials: D
authors.lastname: Maxwell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D019033:Delivery of Health Care, Integrated; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D015999:Multivariate Analysis; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D009674:Nova Scotia; D016017:Odds Ratio; D010166:Palliative Care / Q000379:methods / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors