title: Early admission to community-based palliative care reduces use of emergency departments in the ninety days before death.
abstract: BACKGROUND
  Overcrowded emergency departments (EDs) and the staff within them are often not able to address the complex physical and psychosocial needs of people at the end of life. While some studies have suggested that the ED environment should be adapted and staff trained to address this issue, there are no previous studies which have investigated whether the provision of timely palliative care services could prevent people with palliative care needs from attending EDs.
  
  
  OBJECTIVE
  This study investigates whether early admission to community-based palliative care reduces ED admissions in the last 90 days of life for patients with cancer.
  
  
  METHODS
  The study was a retrospective, cross-sectional study using death registrations and hospital morbidity data for 746 Western Australian adults who died of cancer and where palliative care may have been a viable and appropriate option for care.
  
  
  RESULTS
  In their final 90 days before death, 31.3% of decedents who had early access to palliative care and 52.0% of those who did not have early access to palliative care visited an ED (OR=2.86; 95% CI, 1.91, 4.30). Early admission to community-based palliative care reduces the use of EDs by cancer patients in the 90 days before death.
  
  
  CONCLUSIONS
  Proactive care in the form of timely community-based palliative care assists in preventing vulnerable people at the end of life from being exposed to the stressful ED environment and decreases the pressure on EDs.
authors.affiliation: Centre for Research into Disability and Society and Curtin Health Innovation Research Institute, School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia. bev.mcnamara@curtin.edu.au
authors.forename: Beverley A
authors.initials: BA
authors.lastname: McNamara
authors.forename: Lorna K
authors.initials: LK
authors.lastname: Rosenwax
authors.forename: Kevin
authors.initials: K
authors.lastname: Murray
authors.forename: David C
authors.initials: DC
authors.lastname: Currow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D003153:Community Health Services / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends; D003430:Cross-Sectional Studies; D003644:Death Certificates; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D010166:Palliative Care / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D010343:Patient Admission / Q000592:standards* / Q000639:trends; D012189:Retrospective Studies; D019452:Terminally Ill / Q000706:statistics & numerical data*; D013997:Time Factors; D014904:Western Australia / Q000453:epidemiology; D000078329:Workforce; D055815:Young Adult