A Comparison of the Survival, Place of Death, and Medical Utilization of Terminal Patients Receiving Hospital-Based and Community-Based Palliative Home Care: A Retrospective and Propensity Score Matching Cohort Study.

Cheng-Pei Lin,Min-Shiow Tsay,Yun-Shiuan Chuang,Yi-Hui Chang,Chien-Yi Wu,Ching-Yu Wang,Hung-Cheng Chen

doi:10.3390/ijerph18147272

Abstract

Evidence shows that community-based palliative home care (PHC) provision enhances continuous care and improves patient outcomes. This study compared patient survival, place of death, and medical utilization in community- versus hospital-based PHC. A retrospective cohort study was conducted of patients aged over 18 referred to either community- or hospital-based PHC from May to December 2018 at a tertiary hospital and surrounding communities in Southern Taiwan. A descriptive analysis, Chi-square test, t-test, and Log-rank test were used for the data analysis of 131 hospital-based PHC patients and 43 community-based PHC patients, with 42 paired patient datasets analyzed after propensity score matching. More nurse visits (p = 0.02), fewer emergency-room visits (p = 0.01), and a shorter waiting time to access PHC (p = 0.02) were found in the community group. There was no difference in the duration of survival and hospitalization between groups. Most hospital-based patients (57%) died in hospice wards, while most community-based patients died at home (52%). Community-based PHC is comparable to hospital-based PHC in Taiwan. Although it has fewer staffing and training requirements, it is an alternative for terminal patients to meet the growing end-of-life care demand.

Highlights

Evidence shows that community-based palliative home care (PHC) can be beneficial for older adults by improving cost-effective healthcare with better medical utilization and stakeholders’ satisfaction on care, reducing hospital admission and transition from home to hospitals, and supporting home death with a better quality end of life [9,10,11]
Most patients die within a year after receiving PHC; we followed up the study participants for one year and set the study endpoint as 31 December 2019
No significant difference in patient survival days was found between the two PHC

Summary

Introduction

The aging population is rapidly increasing globally. World Population Aging report 2019, there were approximately 703 million people aged over 65 years worldwide in 2019, and this figure is projected to double to 1.5 billion in. Eastern and south-eastern Asia, Latin America, and the Caribbean are deemed to have the fastest population aging rate, with the percentage of the aged population doubling from 1990 to 2019 (i.e., eastern and south-eastern Asia: 6% to 11%; Latin America and the Caribbean: 5% to 9%) [1].

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Discussion

Conclusion