Abstract
BackgroundSeveral studies have demonstrated the benefits of early initiation of end-of-life care, particularly homecare nursing services. However, there is little research on variations in the timing of when end-of-life homecare nursing is initiated and no established benchmarks.MethodsThis is a retrospective cohort study of patients with a cancer-confirmed cause of death between 2004 and 2009, from three Canadian provinces (British Columbia, Nova Scotia, and Ontario). We linked multiple administrative health databases within each province to examine homecare use in the last 6 months of life. Our primary outcome was mean time (in days) to first end-of-life homecare nursing visit, starting from 6 months before death, by region. We developed an empiric benchmark for this outcome using a funnel plot, controlling for region size.ResultsOf the 28 regions, large variations in the outcome were observed, with the longest mean time (97 days) being two-fold longer than the shortest (55 days). On average, British Columbia and Nova Scotia had the first and second shortest mean times, respectively. The province of Ontario consistently had longer mean times. The empiric benchmark mean based on best-performing regions was 57 mean days.ConclusionsSignificant variation exists for the time to initiation of end-of-life homecare nursing across regions. Understanding regional variation and developing an empiric benchmark for homecare nursing can support health system planners to set achievable targets for earlier initiation of end-of-life care.
Highlights
Several studies have demonstrated the benefits of early initiation of end-of-life care, homecare nursing services
Several studies have demonstrated that early initiation of palliative and end-of-life care in cancer patients has benefits, such as reduced symptoms, improved quality of life, and even longer survival [8,9,10]
The purpose of this study is three-fold: i) to describe the regional variation in the mean time to first end-oflife homecare visit starting from 6 months before death among health regions across British Columbia (BC), Nova Scotia (NS), and Ontario (ON); ii) establish the three-province average with confidence limits for this outcome; and iii) determine a national empiric benchmark based on the best regional performers
Summary
Several studies have demonstrated the benefits of early initiation of end-of-life care, homecare nursing services. There is little research on variations in the timing of when end-of-life homecare nursing is initiated and no established benchmarks. Homecare nursing is critical at end-of-life since it provides complex symptom management, education, and support, which can help to avoid often unnecessary and expensive hospitalizations. Research has shown that the use and intensity of endof-life homecare nursing is strongly associated with a home death [6], and reduced hospitalizations near death [7]. Earlier initiation and more intensity of end-of-life homecare nursing has been associated with reduced hospitalizations and hospital deaths [7, 11, 12]. Despite the growing evidence of the benefits of early initiation of end-of-life care by homecare nurses, little
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