title: The Association Between Home Palliative Care Services and Quality of End-of-Life Care Indicators in the Province of Québec.
abstract: BACKGROUND
  In Canada, governments have increased spending on home care to promote better end-of-life care. In the province of Québec, Canada, home palliative care (PC) services (HPCS) are provided by Public Local Community-Based Health Care Service providers (Centres Locaux de Services Communautaires [CLSC]) with universal coverage. Accordingly, there should be no regional variations of these services and their effect on quality of end-of-life PC (QEoLPC) indicators.
  
  
  OBJECTIVE
  To test if all the CLSCs provided the same level of HPCS to cancer patients in the province of Québec, Canada, and the association between level of HPCS and QEoLPC indicators.
  
  
  METHODS
  Characteristics of 52,316 decedents with cancer were extracted from administrative databases between 2003 and 2006. Two gender-specific "adjusted performance of CLSCs in delivering HPCS" models were created using gender-specific hierarchical regression adjusted for patient and CLSC neighborhood characteristics. Using the same approach, the strength of the association between the adjusted performance of CLSCs in delivering HPCS and the QEoLPC indicators was estimated.
  
  
  RESULTS
  Overall, 27,255 (52.1%) decedents had at least one HPCS. Significant variations in the adjusted performance of CLSC in delivering HPCS were found. Higher performance led to a lower proportion of men having more than one emergency room visit during the last month of life (risk ratio [RR] 0.924; 95% CI 0.867-0.985), and for women, a higher proportion dying at home (RR 2.255; 95% CI 1.703-2.984) and spending less time in hospital (RR 0.765; 95% CI 0.692-0.845).
  
  
  CONCLUSIONS
  Provision of HPCS remained limited in Québec, but when present, they were associated with improved QEoLPC indicators.
authors: Department of Family Medicine and Emergency Medicine, Laval University, Québec City, Canada; Cancer Research Center, Laval University, Québec City, Canada; Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Québec, Canada. Electronic address: Gagnon.Bruno@crchudequebec.ulaval.ca.
authors: Bruno
authors: B
authors: Gagnon
authors: Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Québec, Canada.
authors: Lyne
authors: L
authors: Nadeau
authors: Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Québec, Canada.
authors: Susan
authors: S
authors: Scott
authors: School of Social Work, Laval University, Québec City, Canada; Cancer Research Center, Laval University, Québec City, Canada.
authors: Serge
authors: S
authors: Dumont
authors: Department of Oncology, McGill University, Montreal, Québec, Canada.
authors: Neil
authors: N
authors: MacDonald
authors: Department of Family Medicine and Emergency Medicine, Laval University, Québec City, Canada.
authors: Michèle
authors: M
authors: Aubin
authors: Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Québec, Canada; School of Physical and Occupational Therapy, McGill University, Montreal, Québec, Canada.
authors: Nancy
authors: N
authors: Mayo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D010166:Palliative Care / Q000379:methods* / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care; D011787:Quality of Health Care; D011792:Quebec; D012044:Regression Analysis; D012737:Sex Factors; D013727:Terminal Care / Q000379:methods* / Q000706:statistics & numerical data
keywords: Palliative medicine; administrative databases; home services; nursing; oncology