title: A hospital-based palliative care service for patients with advanced organ failure in sub-Saharan Africa reduces admissions and increases home death rates.
abstract: BACKGROUND
  Despite emerging data of cost savings under palliative care in various regions, no such data have been generated in response to the high burden of terminal illness in Africa.
  
  
  OBJECTIVE
  This evaluation of a novel hospital-based palliative care service for patients with advanced organ failure in urban South Africa aimed to determine whether the service reduces admissions and increases home death rates compared with the same fixed time period of standard hospital care.
  
  
  METHODS
  Data on admissions and place of death were extracted from routine hospital activity records for a fixed period before death, using standard patient daily expense rates. Data from the first 56 consecutive deaths under the new service (intervention group) were compared with 48 consecutive deaths among patients immediately before the new service (historical controls).
  
  
  RESULTS
  Among the intervention and control patients, 40 of 56 (71.4%) and 47 of 48 (97.9%), respectively, had at least one admission (P < 0.001). The mean number of admissions for the intervention and control groups was 1.39 and 1.98, respectively (P < 0.001). The mean total number of days spent admitted for intervention and control groups was 4.52 and 9.3 days, respectively (P < 0.001). For the intervention and control patients, a total of 253 and 447 admission days were recorded, respectively, with formal costs of $587 and $1209, respectively. For the intervention and control groups, home death was achieved by 33 of 56 (58.9%) and nine of 48 (18.8%), respectively (P ≤ 0.001).
  
  
  CONCLUSIONS
  These data demonstrate that an outpatient hospital-based service reduced admissions and improved the rate of home deaths and offers a feasible and cost-effective model for such settings.
authors: Victoria Hospital, Cape Town, South Africa; Cornell University, Ithaca, New York, USA.
authors: Taylor
authors: T
authors: Desrosiers
authors: Victoria Hospital, Cape Town, South Africa; University of Cape Town, Cape Town, South Africa.
authors: Clint
authors: C
authors: Cupido
authors: Victoria Hospital, Cape Town, South Africa.
authors: Elizabeth
authors: E
authors: Pitout
authors: Victoria Hospital, Cape Town, South Africa; University of Cape Town, Cape Town, South Africa.
authors: Lindi
authors: L
authors: van Niekerk
authors: University of Cape Town, Cape Town, South Africa.
authors: Motasim
authors: M
authors: Badri
authors: University of Cape Town, Cape Town, South Africa; Hospice Palliative Care Association of South Africa, Cape Town, South Africa.
authors: Liz
authors: L
authors: Gwyther
authors: University of Cape Town, Cape Town, South Africa; King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, United Kingdom. Electronic address: richard.harding@kcl.ac.uk.
authors: Richard
authors: R
authors: Harding
mesh_terms: D000368:Aged; D004469:Economics, Hospital; D005260:Female; D006739:Hospital Administration / Q000191:economics / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data*; D013019:South Africa; D013727:Terminal Care / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data*; D019037:Urban Health Services / Q000191:economics / Q000706:statistics & numerical data
keywords: Africa; Palliative care; admissions; costs; evaluation; hospital; organ failure; place of death; terminal care