title: Using more end-of-life homecare services is associated with using fewer acute care services: a population-based cohort study.
abstract: BACKGROUND
  Healthcare systems are investing in end-of-life homecare to reduce acute care use. However, little evidence exists on the timing and amount of homecare services necessary to reduce acute care utilization.
  
  
  OBJECTIVE
  To investigate whether admission time to homecare and the amount of services, as measured by average nursing and personal support and homemaking (PSH) hours/week (h/wk), are associated with using acute care services at end-of-life.
  
  
  METHODS
  Retrospective observational cohort study.
  
  
  METHODS
  Decedents admitted to end-of-life homecare in Ontario, Canada.
  
  
  METHODS
  The odds ratios (OR) of having a hospitalization or emergency room visit in the 2 weeks before death and dying in a hospital.
  
  
  RESULTS
  The cohort (n = 9018) used an average of 3.11 (SD = 4.87) nursing h/wk, 3.18 (SD = 6.89) PSH h/wk, and 18% were admitted to homecare for <1 month. As admission time to death and homecare services increased, the adjusted OR of an outcome decreased in a dose response manner. Patients admitted earlier than 6 months before death had a 35% (95% CI: 25%-44%) lower OR of hospitalization than those admitted 3 to 4 weeks before death; patients using more than 7 nursing h/wk and more than 7 PSH h/wk had a 50% (95% CI: 37%-60%) and 35% (95% CI: 21%-47%) lower OR of a hospitalization, respectively, than patients using 1 h/wk, controlling for other covariates. Other outcomes had similar results.
  
  
  CONCLUSIONS
  These results suggest that early homecare admission and increased homecare services will help alleviate the demand for hospital resources at end-of-life.
authors.affiliation: Department of Oncology, McMaster University, Hamilton, Ontario, Canada. hsienseow@gmail.com
authors.forename: Hsien
authors.initials: H
authors.lastname: Seow
authors.forename: Lisa
authors.initials: L
authors.lastname: Barbera
authors.forename: Doris
authors.initials: D
authors.lastname: Howell
authors.forename: Sydney M
authors.initials: SM
authors.lastname: Dy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006297:Health Services Accessibility; D006699:Home Care Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009864:Ontario; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012017:Referral and Consultation; D012189:Retrospective Studies; D013727:Terminal Care; D013997:Time Factors