title: Quality of care and rehospitalization rate in the last stage of disease in brain tumor patients assisted at home: a cost effectiveness study.
abstract: Despite aggressive multimodality treatment the prognosis of patients with primary brain tumors (BT) remains poor. At present, there are no data about the role of palliative home-care services and their impact on quality of care. We report the results of a pilot project of palliative home care for BT patients started in 2000 in the National Cancer Institute Regina Elena of Rome. We report also the result of a cost/effectiveness analysis utilizing administrative data on re-hospitalization rate in the last two months of life.
  
  
  METHODS
  Since October 2000 until December 2009, 572 patients have been followed by our home care staff. Among 394 patients who died, 276 (70%) were followed at home until death. A cost/effectiveness analysis was carried out evaluating the rehospitalization rate in the last 2 months of life in a subgroup of patients (group 1 assisted at home, 72 patients; group 2 not assisted at home, 71). The number of hospital readmission in the last 2 months of life, and length and cost of hospitalization were retrospectively analyzed from hospital discharge records.
  
  
  RESULTS
  Hospitalization rate of group 1 (16.7%) was lower than group 2 (38%) (95% CI: 0.18-0.65, p = 0.001). Costs of hospitalization also differed substantially: 517 Euros (95% CI: 512-522) in group 1 vs 24, 076 Euros (95%: 24,040-24,112 Euros) in group 2.
  
  
  CONCLUSIONS
  Home-care may represent an alternative to in-hospital care for the management of brain tumor patients and may improve the end-of-life quality of care.
authors.affiliation: National Cancer Institute Regina Elena, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Pace
authors.forename: Cherubino
authors.initials: C
authors.lastname: Di Lorenzo
authors.forename: Alessandra
authors.initials: A
authors.lastname: Capon
authors.forename: Veronica
authors.initials: V
authors.lastname: Villani
authors.forename: Dario
authors.initials: D
authors.lastname: Benincasa
authors.forename: Lara
authors.initials: L
authors.lastname: Guariglia
authors.forename: Maurizio
authors.initials: M
authors.lastname: Salvati
authors.forename: Christian
authors.initials: C
authors.lastname: Brogna
authors.forename: Valentino
authors.initials: V
authors.lastname: Mantini
authors.forename: Antonio
authors.initials: A
authors.lastname: Mastromattei
authors.forename: Alfredo
authors.initials: A
authors.lastname: Pompili
mesh_terms: D001932:Brain Neoplasms / Q000191:economics / Q000628:therapy*; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006699:Home Care Services / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000191:economics; D010359:Patient Readmission / Q000706:statistics & numerical data; D010865:Pilot Projects; D011787:Quality of Health Care; D012189:Retrospective Studies; D012384:Rome