title: Palliative homecare is associated with reduced high- and low-acuity emergency department visits at the end of life: A population-based cohort study of cancer decedents.
abstract: Prior work shows that palliative homecare services reduce the subsequent need for hospitalizations and emergency services; however, no study has investigated whether this association is present for emergency department visits of high acuity or whether it only applies to low-acuity emergency department visits.
  
  
  
  To examine the association between palliative versus standard homecare nursing and the rate of high-acuity and low-acuity emergency department visits among cancer decedents during their last 6 months of life.
  
  
  
  This is a retrospective cohort study of end-of-life homecare patients in Ontario, Canada, who had confirmed cancer cause of death from 2004 to 2009. A multivariable Poisson regression analysis was implemented to examine the association between the receipt of palliative homecare nursing (vs standard homecare nursing) and the rate of high- and low-acuity emergency department visits, separately.
  
  
  
  There were 54,743 decedents who received homecare nursing in the last 6 months of life. The receipt of palliative homecare nursing decreased the rate of low-acuity emergency department visits (relative rate = 0.53, 95% confidence interval = 0.50-0.56) and was significantly associated with a larger decrease in the rate of high-acuity emergency department visits (relative rate = 0.37, 95% confidence interval = 0.35-0.38).
  
  
  
  Receiving homecare nursing with palliative intent may decrease the need for dying cancer patients to visit the emergency department, for both high and low-acuity visits, compared to receiving general homecare nursing. Policy implications include building support for additional training in palliative care to generalist homecare nurses and increasing access to palliative homecare nursing.
authors: 1 Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.|2 Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.|3 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
authors: Rinku
authors: R
authors: Sutradhar
authors: 1 Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.|3 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.|4 Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
authors: Lisa
authors: L
authors: Barbera
authors: 1 Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.|2 Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.|5 Department of Oncology, McMaster University, Hamilton, ON, Canada.
authors: Hsien-Yeang
authors: HY
authors: Seow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006699:Home Care Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality* / Q000451:nursing*; D009864:Ontario; D010166:Palliative Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D012044:Regression Analysis; D012189:Retrospective Studies; D013727:Terminal Care / Q000458:organization & administration* / Q000706:statistics & numerical data
keywords: Palliative homecare nursing; Poisson regression; emergency department visits; high acuity; low acuity; relative rate