title: Resource utilization and cost analyses of home-based palliative care service provision: the Niagara West End-of-Life Shared-Care Project.
abstract: BACKGROUND
  Increasing emphasis is being placed on the economics of health care service delivery - including home-based palliative care.
  
  
  OBJECTIVE
  This paper analyzes resource utilization and costs of a shared-care demonstration project in rural Ontario (Canada) from the public health care system's perspective.
  
  
  METHODS
  To provide enhanced end-of-life care, the shared-care approach ensured exchange of expertise and knowledge and coordination of services in line with the understood goals of care. Resource utilization and costs were tracked over the 15 month study period from January 2005 to March 2006.
  
  
  RESULTS
  Of the 95 study participants (average age 71 years), 83 had a cancer diagnosis (87%); the non-cancer diagnoses (12 patients, 13%) included mainly advanced heart diseases and COPD. Community Care Access Centre and Enhanced Palliative Care Team-based homemaking and specialized nursing services were the most frequented offerings, followed by equipment/transportation services and palliative care consults for pain and symptom management. Total costs for all patient-related services (in 2007 $CAN) were $1,625,658.07 - or $17,112.19 per patient/$117.95 per patient day.
  
  
  CONCLUSIONS
  While higher than expenditures previously reported for a cancer-only population in an urban Ontario setting, the costs were still within the parameters of the US Medicare Hospice Benefits, on a par with the per diem funding assigned for long-term care homes and lower than both average alternate level of care and hospital costs within the Province of Ontario. The study results may assist service planners in the appropriate allocation of resources and service packaging to meet the complex needs of palliative care populations.
authors.affiliation: University of Toronto, Institute of Health Policy, Management and Evaluation, Canada.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Klinger
authors.forename: Doris
authors.initials: D
authors.lastname: Howell
authors.forename: Denise
authors.initials: D
authors.lastname: Marshall
authors.forename: David
authors.initials: D
authors.lastname: Zakus
authors.forename: Kevin
authors.initials: K
authors.lastname: Brazil
authors.forename: Raisa B
authors.initials: RB
authors.lastname: Deber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000191:economics; D006699:Home Care Services / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000451:nursing; D009864:Ontario; D010166:Palliative Care / Q000191:economics* / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000191:economics / Q000706:statistics & numerical data