title: Intensity of Integrated Primary and Specialist Home-Based Palliative Care for Chronic Diseases in Northeast Italy and Its Impact on End-of-Life Hospital Access.
abstract: Hospital admissions at the end of life (EOL) represent an established indicator of poor quality of care.
  
  
  
  To examine the impact of intensity of integrated primary and specialist home-based palliative care for chronic diseases (HPCCD) plans of care on EOL hospital access.
  
  
  
  Retrospective population-based study using linked mortality, hospitalization, and home care data. Intensity of HPCCD was measured 90-31 days before death; outcomes were hospital death and prolonged hospital stay for medical reasons in the last month of life. Outcomes were modeled through Poisson and quartile regressions. Adults aged 65-84 years with at least an ordinary hospitalization and a drug treatment in the year before death, who died from nononcological chronic diseases in the Veneto Region, January 2012-December 2013, were included.
  
  
  
  Among 2087 patients, 1016 (48.7%) did not receive any HPCCD homecare visit; 860 (41.2%), 152 (7.3%), and 59 (2.8%) had <2, 2-4, and 4-7 homecare visits/week, respectively. Hospital death occurred for 1310 patients (62.8%) and the median hospital stay in the last month of life was five days (interquartile range 0-14). In multivariate analysis, a higher intensity of HPCCD was associated with lower rates of prolonged (≥14 days) EOL hospitalization and hospital death with a dose-response relationship. When no access to HPCCD was compared with 2-4 visits/week, adjusted percentage of hospital death decreased by -18.4% (95% confidence interval [CI] -5.4% to -29.7%) and the length of hospital stay decreased by 37.9% (95% CI 16.7%-56.0%).
  
  
  
  The intensity of integrated HPCCD plans of care was associated with a reduction in EOL hospital stay and in hospital death.
authors.affiliation: 1 Epidemiological Department of the Veneto Region , Padua, Italy .
authors.forename: Eliana
authors.initials: E
authors.lastname: Ferroni
authors.affiliation: 1 Epidemiological Department of the Veneto Region , Padua, Italy .
authors.forename: Francesco
authors.initials: F
authors.lastname: Avossa
authors.affiliation: 2 Palliative Care Unit , Local Health Unit No. 4, Thiene, Italy .
authors.forename: Franco
authors.initials: F
authors.lastname: Figoli
authors.affiliation: 3 Primary Care , Local Health Unit No. 7, Conegliano Veneto, Italy .
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cancian
authors.affiliation: 4 Palliative Care Unit , Local Health Unit No. 7, Pieve di Soligo, Italy .
authors.forename: Cosimo
authors.initials: C
authors.lastname: De Chirico
authors.affiliation: 1 Epidemiological Department of the Veneto Region , Padua, Italy .
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Pinato
authors.affiliation: 1 Epidemiological Department of the Veneto Region , Padua, Italy .
authors.forename: Michele
authors.initials: M
authors.lastname: Pellizzari
authors.affiliation: 1 Epidemiological Department of the Veneto Region , Padua, Italy .
authors.forename: Ugo
authors.initials: U
authors.lastname: Fedeli
authors.affiliation: 1 Epidemiological Department of the Veneto Region , Padua, Italy .
authors.forename: Mario
authors.initials: M
authors.lastname: Saugo
authors.affiliation: 5 Health and Social Services of the Veneto Region , Venice, Italy .
authors.forename: Domenico
authors.initials: D
authors.lastname: Mantoan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D006760:Hospitalization; D006801:Humans; D007558:Italy; D010166:Palliative Care; D012189:Retrospective Studies; D013727:Terminal Care
keywords: chronic diseases; end-of-life; hospital death; hospitalization; palliative care