The Effect of Community-Based Specialist Palliative Care Teams on Place of Care.
BACKGROUND
Prior research on community-based specialist palliative care teams used outcome measures of place of death and/or dichotomous outcome measures of acute care use in the last two weeks of life. However, existing research seldom measured the diverse places of care used and their timing prior to death.


OBJECTIVE
The study objective was to examine the place of care in the last 30 days of life.


METHODS
In this retrospective cohort study, patients who received care from a specialist palliative care team (exposed) were matched by propensity score to patients who received usual care in the community (unexposed) in Ontario, Canada. Measured was the percentage of patients in each place of care in the last month of life as a proportion of the total cohort.


RESULTS
After matching, 3109 patients were identified in each group, where 79% had cancer and 77% received end-of-life home care. At 30 days compared to 7 days before death, the exposed group's proportions rose from 33% to 41% receiving home care and 14% to 15% in hospital, whereas the unexposed group's proportions rose from 28% to 32% receiving home care and 16% to 22% in hospital. Linear trend analysis (proportion over time) showed that the exposed group used significantly more home care services and fewer hospital days (p < 0.001) than the unexposed group. On the last day of life (place of death), the exposed group had 18% die in an in-patient hospital bed compared to 29% in usual care.


CONCLUSIONS
Examining place of care in the last month can effectively illustrate the service use trajectory over time.
1 Department of Oncology, Hamilton, Ontario, Canada .
Hsien
H
Seow
2 McMaster University , Hamilton, Ontario, Canada .
Gagan
G
Dhaliwal
3 Department of Oncology, University of Alberta , Edmonton, Alberta, Canada .
Konrad
K
Fassbender
4 Institute for Clinical Evaluative Sciences , Toronto, Ontario, Canada .
Jagadish
J
Rangrej
5 School of Nursing and Midwifery, Queen's University Belfast , Belfast, Northern Ireland, United Kingdom .
Kevin
K
Brazil
3 Department of Oncology, University of Alberta , Edmonton, Alberta, Canada .
Robin
R
Fainsinger
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003153:Community Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006699:Home Care Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000451:nursing*; D009864:Ontario; D010166:Palliative Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013727:Terminal Care / Q000458:organization & administration* / Q000706:statistics & numerical data