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Effectiveness of palliative care services: A population-based study of end-of-life care for cancer patients.
De Palma, Rossana; Fortuna, Daniela; Hegarty, Sarah E; Louis, Daniel Z; Melotti, Rita Maria; Moro, Maria Luisa.
Afiliación
  • De Palma R; 1 Regional Agency for Health and Social Care, Bologna, Italy.
  • Fortuna D; 1 Regional Agency for Health and Social Care, Bologna, Italy.
  • Hegarty SE; 2 Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
  • Louis DZ; 2 Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
  • Melotti RM; 3 Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy.
  • Moro ML; 1 Regional Agency for Health and Social Care, Bologna, Italy.
Palliat Med ; 32(8): 1344-1352, 2018 09.
Article en En | MEDLINE | ID: mdl-29886795
BACKGROUND: Multiple studies demonstrate substantial utilization of acute hospital care and, potentially excessive, intensive medical and surgical treatments at the end-of-life. AIM: To evaluate the relationship between the use of home and facility-based hospice palliative care for patients dying with cancer and service utilization at the end of life. DESIGN: Retrospective, population-level study using administrative databases. The effect of palliative care was analyzed between coarsened exact matched cohorts and evaluated through a conditional logistic regression model. SETTING/PARTICIPANTS: The study was conducted on the cohort of 34,357 patients, resident in Emilia-Romagna Region, Italy, admitted to hospital with a diagnosis of metastatic or poor-prognosis cancer during the 6 months before death between January 2013 and December 2015. RESULTS: Patients who received palliative care experienced significantly lower rates of all indicators of aggressive care such as hospital admission (odds ratio (OR) = 0.05, 95% confidence interval (CI): 0.04-0.06), emergency department visits (OR = 0.23, 95% CI: 0.21-0.25), intensive care unit stays (OR = 0.29, 95% CI: 0.26-0.32), major operating room procedures (OR = 0.22, 95% CI: 0.21-0.24), and lower in-hospital death (OR = 0.11, 95% CI: 0.10-0.11). This cohort had significantly higher rates of opiate prescriptions (OR = 1.27, 95% CI: 1.21-1.33) ( p < 0.01 for all comparisons). CONCLUSION: Use of palliative care at the end of life for cancer patients is associated with a reduction of the use of high-cost, intensive services. Future research is necessary to evaluate the impact of increasing use of palliative care services on other health outcomes. Administrative databases linked at the patient level are a useful data source for assessment of care at the end of life.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Cuidados Paliativos / Cuidado Terminal / Cuidados Paliativos al Final de la Vida / Neoplasias Tipo de estudio: Etiology_studies / Evaluation_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies / Screening_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Palliat Med Asunto de la revista: SERVICOS DE SAUDE Año: 2018 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Reino Unido

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Cuidados Paliativos / Cuidado Terminal / Cuidados Paliativos al Final de la Vida / Neoplasias Tipo de estudio: Etiology_studies / Evaluation_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies / Screening_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Palliat Med Asunto de la revista: SERVICOS DE SAUDE Año: 2018 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Reino Unido