title: Predictors of health service use over the palliative care trajectory.
abstract: BACKGROUND
  Health system restructuring coupled with the preference of patients to be cared for at home has altered the setting for the provision of palliative care. Accordingly, there has been emphasis on the provision of home-based palliative care by multidisciplinary teams of health care providers. Evidence suggests that these teams are better able to identify and deal with the needs of patients and their family members. Currently there is a lack of literature examining the predictors of palliative care service use for various professional service categories.
  
  
  OBJECTIVE
  The purpose of this study was to examine the predictors of the propensity and intensity of five main health service categories in the last three months of life for home-based palliative care patients.
  
  
  METHODS
  This was a prospective cohort study. The predictors of service use were assessed using a two-part model, which treats the decision to use a service (propensity) and the amount of service use (intensity) as two distinct processes. Propensity was modeled using a logistic regression and intensity was modeled using ordinary least squares regression.
  
  
  RESULTS
  The results indicate that each service category emerged with a different set of predictor variables. Common predictors of health service use across service categories were patient age and functional status. The results suggest that a consistent set of predictors across service categories does not exist, and thus the determinants of access to each service category are unique.
  
  
  CONCLUSIONS
  These findings will help case managers, health administrators, and policy decision makers better allocate human resources to palliative patients.
authors: Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors: Lisa
authors: L
authors: Masucci
authors: Denise N
authors: DN
authors: Guerriere
authors: Brandon
authors: B
authors: Zagorski
authors: Peter C
authors: PC
authors: Coyte
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D010166:Palliative Care / Q000706:statistics & numerical data*; D057240:Patient Preference; D057216:Propensity Score; D011446:Prospective Studies