title: Does Increasing Home Care Nursing Reduce Emergency Department Visits at the End of Life? A Population-Based Cohort Study of Cancer Decedents.
abstract: BACKGROUND
  Despite being commonplace in health care systems, little research has described home care nursing's effectiveness to reduce acute care use at the end of life.
  
  
  OBJECTIVE
  To examine the temporal association between home care nursing rate on emergency department (ED) visit rate in the subsequent week during the last six months of life.
  
  
  METHODS
  We conducted a retrospective cohort study of end-of-life cancer decedents in Ontario, Canada, from 2004 to 2009 by linking administrative databases. We examined the association between home care nursing rate of one week with the ED rate in the subsequent week closer to death, controlling for covariates and repeated measures among decedents. Nursing was dichotomized into standard and end-of-life care intent.
  
  
  RESULTS
  Our cohort included 54,576 decedents who used home care nursing services in the last six months before death, where 85% had an ED visit and 68% received end-of-life home care nursing. Patients receiving end-of-life nursing at any week had a significantly reduced ED rate in the subsequent week of 31% (relative rate [RR] 0.69; 95% confidence interval [CI] 0.68, 0.71) compared with standard nursing. In the last month of life, receiving end-of-life nursing and standard nursing rate of more than five hours/week was associated with a decreased ED rate of 41% (RR 0.59, 95% CI 0.58, 0.61) and 32% (RR 0.68, 95% CI 0.66, 0.70), respectively, compared with standard nursing of one hour/week.
  
  
  CONCLUSIONS
  Our study showed a temporal association between receiving end-of-life nursing in a given week during the last six months of life, and of more standard nursing in the last month of life, with a reduced ED rate in the subsequent week.
authors.affiliation: Department of Oncology, McMaster University, Hamilton, Ontario, Canada; Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada. Electronic address: seowh@mcmaster.ca.
authors.forename: Hsien
authors.initials: H
authors.lastname: Seow
authors.affiliation: Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Odette Cancer Centre, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Barbera
authors.affiliation: British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada.
authors.forename: Reka
authors.initials: R
authors.lastname: Pataky
authors.affiliation: Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Beverley
authors.initials: B
authors.lastname: Lawson
authors.affiliation: Department of Oncology, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Erin
authors.initials: E
authors.lastname: O'Leary
authors.affiliation: Department of Palliative Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Konrad
authors.initials: K
authors.lastname: Fassbender
authors.affiliation: Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Kim
authors.initials: K
authors.lastname: McGrail
authors.affiliation: Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Fred
authors.initials: F
authors.lastname: Burge
authors.affiliation: Department of Oncology, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Melissa
authors.initials: M
authors.lastname: Brouwers
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Rinku
authors.initials: R
authors.lastname: Sutradhar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital; D005260:Female; D064650:Home Health Nursing / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality* / Q000628:therapy*; D009864:Ontario / Q000453:epidemiology; D010166:Palliative Care / Q000379:methods / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012044:Regression Analysis; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods* / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: End of life; cancer; emergency department use; home care; nursing; palliative care