title: Predictors of home care expenditures and death at home for cancer patients in an integrated comprehensive palliative home care pilot program.
abstract: OBJECTIVE
  Empirical understanding of predictors for home care service use and death at home is important for healthcare planning. Few studies have examined these predictors in the context of the publicly funded Canadian home care system. This study examined predictors for home care use and home death in the context of a "gold standard" comprehensive palliative home care program pilot in Ontario where patients had equal access to home care services.
  
  
  METHODS
  Secondary clinical and administrative data sources were linked using a unique identifier to examine multivariate factors (predisposing, enabling, need) on total home care expenditures and home death for a cohort of cancer patients enrolled in the HPCNet pilot.
  
  
  RESULTS
  SUBJECTS WITH GASTROINTESTINAL SYMPTOMS (OR: 1.64; p=0.03) and those with higher income had increased odds of dying at home (OR: 1.14; p<0.001), whereas age, number of GP visits, gastrointestinal symptoms (i.e., nausea, vomiting, bowel obstruction) and eating problems (i.e., anorexia/cachexia) predicted home care expenditures.
  
  
  CONCLUSIONS
  Predictors of home death found in earlier studies appeared less important in this comprehensive palliative home care pilot. An income effect for home death observed in this study requires examination in future controlled studies.
  
  
  CONCLUSIONS
  Access to palliative home care that is adequately resourced and organized to address the multiple domains of issues that patients/families experience at the end of life has the potential to enable home death and shift care appropriately from limited acute care resources.
authors.affiliation: Princess Margaret Hospital, University Health Network, Toronto, ON.
authors.forename: Doris M
authors.initials: DM
authors.lastname: Howell
authors.forename: Tom
authors.initials: T
authors.lastname: Abernathy
authors.forename: Rhonda
authors.initials: R
authors.lastname: Cockerill
authors.forename: Kevin
authors.initials: K
authors.lastname: Brazil
authors.forename: Frank
authors.initials: F
authors.lastname: Wagner
authors.forename: Larry
authors.initials: L
authors.lastname: Librach