title: Integrating palliative care across settings: A retrospective cohort study of a hospice home care programme for cancer patients.
abstract: Terminally ill patients at the end-of-life do transit between care settings due to their complex care needs. Problems of care fragmentation could result in poor quality of care.
  
  
  
  We aimed to evaluate the impact of an integrated hospice home care programme on acute care service usage and on the share of home deaths.
  
  
  
  The retrospective study cohort comprised patients who were diagnosed with cancer, had an expected prognosis of 1 year or less, and were referred to a home hospice. The intervention group comprised deceased patients enrolled in the integrated hospice home care programme between September 2012 and June 2014. The historical comparison group comprised deceased patients who were referred to other home hospices between January 2007 and January 2011.
  
  
  
  There were 321 cases and 593 comparator subjects. Relative to the comparator group, the share of hospital deaths was significantly lower for programme participants (12.1% versus 42.7%). After adjusting for differences at baseline, the intervention group had statistically significantly lower emergency department visits at 30 days (incidence rate ratio: 0.38; 95% confidence interval: 0.31-0.47), 60 days (incidence rate ratio: 0.61; 95% confidence interval: 0.54-0.69) and 90 days (incidence rate ratio: 0.69; 95% confidence interval: 0.62-0.77) prior to death. Similar results held for the number of hospitalisations at 30 days (incidence rate ratio: 0.48; 95% confidence interval: 0.40-0.58), 60 days (incidence rate ratio: 0.71; 95% confidence interval: 0.62-0.82) and 90 days (incidence rate ratio: 0.77; 95% confidence interval: 0.68-0.88) prior to death.
  
  
  
  Our results demonstrated that by integrating services between acute care and home hospice care, a reduction in acute care service usage could occur.
authors: Health Services & Outcomes Research Department, National Healthcare Group, Singapore woan_shin_tan@nhg.com.sg.
authors: Woan Shin
authors: WS
authors: Tan
authors: Palliative Medicine Department, Tan Tock Seng Hospital, Singapore Dover Park Hospice, Singapore.
authors: Angel
authors: A
authors: Lee
authors: Palliative Medicine Department, Tan Tock Seng Hospital, Singapore Dover Park Hospice, Singapore.
authors: Sze Yee
authors: SY
authors: Yang
authors: Dover Park Hospice, Singapore.
authors: Susan
authors: S
authors: Chan
authors: Palliative Medicine Department, Tan Tock Seng Hospital, Singapore Dover Park Hospice, Singapore.
authors: Huei Yaw
authors: HY
authors: Wu
authors: Health Services & Outcomes Research Department, National Healthcare Group, Singapore.
authors: Charis Wei Ling
authors: CW
authors: Ng
authors: Health Services & Outcomes Research Department, National Healthcare Group, Singapore.
authors: Bee Hoon
authors: BH
authors: Heng
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D006699:Home Care Services / Q000458:organization & administration*; D017051:Hospice Care / Q000458:organization & administration*; D006738:Hospices / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000451:nursing*; D010166:Palliative Care / Q000458:organization & administration*; D012189:Retrospective Studies; D013727:Terminal Care / Q000458:organization & administration*
keywords: Programme evaluation; advance care planning; home care services; neoplasms; palliative care