title: Predictors of hospital stay and home care services use: a population-based, retrospective cohort study in stage IV gastric cancer.
abstract: BACKGROUND
  Home care services use has been proposed as a means of reducing costs in palliative care by decreasing hospital stay without impacting quality of clinical care; however, little is known about utilization of these services in the time following a terminal cancer diagnosis.
  
  
  OBJECTIVE
  To examine disease, patient and healthcare system predictors of hospital stay, and home care services use in metastatic gastric cancer patients.
  
  
  METHODS
  This is a population-based, retrospective cohort study. Chart review and administrative data were linked, using a 26-month time horizon to collect health services data.
  
  
  METHODS
  All patients diagnosed with metastatic gastric cancer in the province of Ontario between 2005 and 2008 were included in the study (n = 1433).
  
  
  RESULTS
  Age, comorbidity, tumor location, and burden of metastatic disease were identified as predictors of hospital stay and receipt of home care services. Individuals who received home care services spent fewer days in hospital than individuals who did not (relative risk: 0.44; 95% confidence interval: 0.38-0.51). Patients who interacted with a high-volume oncology specialist had shorter cumulative hospital stay (relative risk: 0.62; 95% confidence interval: 0.54-0.71) and were less likely to receive home care services (relative risk: 0.80; 95% confidence interval: 0.72-0.88) than those who did not.
  
  
  CONCLUSIONS
  Examining how differences in hospital stay and home care services use impact clinical outcomes and how policies may reduce costs to the healthcare system is necessary.
authors.affiliation: Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.
authors.forename: Alyson L
authors.initials: AL
authors.lastname: Mahar
authors.affiliation: Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada Institute for Clinical Evaluative Sciences, Toronto, ON, Canada natalie.coburn@sunnybrook.ca.
authors.forename: Natalie G
authors.initials: NG
authors.lastname: Coburn
authors.affiliation: Department of Public Health Sciences, Queen's University, Kingston, ON, Canada Division of Palliative Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada.
authors.forename: Raymond
authors.initials: R
authors.lastname: Viola
authors.affiliation: Department of Public Health Sciences, Queen's University, Kingston, ON, Canada Institute for Clinical Evaluative Sciences, Toronto, ON, Canada Centre for Health Services and Policy Research, Queen's University, Kingston, ON, Canada.
authors.forename: Ana P
authors.initials: AP
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006302:Health Services Research; D006699:Home Care Services / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010166:Palliative Care / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000628:therapy*; D055815:Young Adult
keywords: Home care services; gastric neoplasms; health services research; hospitalization; palliative care; terminal care