title: Association between referral-to-death interval and location of death of patients referred to a hospital-based specialist palliative care service.
abstract: BACKGROUND
  The time interval between palliative care referral and death may play a role in determining the last place of care and location of death of patients referred to palliative care teams.
  
  
  OBJECTIVE
  To examine the association between the referral-to-death interval and location of death of patients referred to a hospital-based palliative care service in Singapore.
  
  
  METHODS
  A retrospective analysis of data from a palliative care service's administrative database was performed. Individual patient's referral-to-death interval was calculated using the date of first contact with the service and date of death. Multinomial regression analysis was done to determine the influence of referral-to-death interval in predicting death at home and in an inpatient hospice facility compared with death in hospital, separately by gender.
  
  
  RESULTS
  Of 842 patients, 52% were female and 56% were aged 65 years or older. Terminal cancer was the diagnosis for most patients (86%). Three hundred ninety patients (46%) died outside the hospital setting. A referral-to-death interval of ≥30 days (as opposed to <30 days) was associated with an increased likelihood of dying at home (odds ratio [OR] 2.21, 95% CI 1.34-3.67 for males and OR 3.33, 95% CI 2.07-5.35 for females) or in an inpatient hospice facility (OR 2.02, 95% CI 1.13-3.60 for males and OR 2.69, 95% CI 1.55-4.66 for females) compared with death in hospital. Male patients' age, ethnicity, and marital status were found to be the contributing factors in predicting death at home.
  
  
  CONCLUSIONS
  Longer referral-to-death interval was associated with death outside the hospital for patients enrolled in a hospital-based service. The study highlights the importance of early referral in predicting the last place of care and location of death of palliative care patients.
authors.affiliation: Lien Centre for Palliative Care, Duke-NUS Graduate Medical School Singapore, Singapore.
authors.forename: Jissy Vijo
authors.initials: JV
authors.lastname: Poulose
authors.forename: Young Kyung
authors.initials: YK
authors.lastname: Do
authors.forename: Patricia Soek Hui
authors.initials: PS
authors.lastname: Neo
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008017:Life Expectancy; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality* / Q000451:nursing*; D010166:Palliative Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D017678:Sex Distribution; D016019:Survival Analysis; D013727:Terminal Care / Q000706:statistics & numerical data; D055815:Young Adult