title: Clinical and Socio-Demographic Predictors of Home Hospice Patients Dying at Home: A Retrospective Analysis of Hospice Care Association's Database in Singapore.
abstract: Hospice care can be delivered in different settings, but many patients choose to receive it at home because of familiar surroundings. Despite their preferences, not every home hospice patient manages to die at home.
  
  
  
  To examine the independent factors associated with home hospice patient dying at home.
  
  
  
  Retrospective analysis of Hospice Care Association's database. Hospice Care Association is the largest home hospice provider in Singapore. The study included all patients who were admitted into home hospice service from January 1, 2004 to December 31, 2013. Cox proportional hazards modeling with time as constant was used to study the relationship between independent variables and home death.
  
  
  
  A total of 19,721 patients were included in the study. Females (adjusted risk ratio [ARR] 1.09, 95% CI 1.04-1.15), older patients (ARR 1.01, 95% CI 1.00-1.01), shorter duration of home hospice stay (ARR 0.88, 95% CI 0.82-0.94), fewer episodes of hospitalization (ARR 0.81, 95% CI 0.75-0.86), living with caregivers (ARR 1.54, 95% CI 1.05-2.26), doctor (ARR 1.05, 95% CI 1.01-1.08) and nurse (ARR 1.06, 95% CI 1.04-1.08) visits were positive predictors of dying-at-home. Diagnosis of cancer (ARR 0.93, 95% CI 0.86-1.00) was a negative predictor of dying-at-home.
  
  
  
  Female, older age, living with a caregiver, non-cancer diagnosis, more doctor and nurse visits, shorter duration of home hospice stays, and fewer episodes of acute hospitalizations are predictive of dying-at-home for home hospice patients.
authors.affiliation: National University Health System (NUHS), Singapore, Singapore. Electronic address: every92002@yahoo.com.
authors.forename: Yee Song
authors.initials: YS
authors.lastname: Lee
authors.affiliation: Khoo Teck Puat Hospital, Singapore, Singapore.
authors.forename: Ramaswamy
authors.initials: R
authors.lastname: Akhileswaran
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.
authors.forename: Eng Hock Marcus
authors.initials: EHM
authors.lastname: Ong
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
authors.forename: Win
authors.initials: W
authors.lastname: Wah
authors.affiliation: University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: David
authors.initials: D
authors.lastname: Hui
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
authors.forename: Sheryl Hui-Xian
authors.initials: SH
authors.lastname: Ng
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
authors.forename: Gerald
authors.initials: G
authors.lastname: Koh
mesh_terms: D000368:Aged; D003643:Death; D005260:Female; D006699:Home Care Services; D017051:Hospice Care; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000401:mortality / Q000628:therapy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology
keywords: Palliative care; cancer; home care; home hospice; hospice care; neoplasm; place of death