Abstract

PurposeTo evaluate whether the early identification of patients who may benefit from palliative care impacts on the use of palliative, community and acute-based care services.MethodsBetween 2014 and 2017, physicians from eight sites were encouraged to systematically identify patients who were likely to die within one year and would were thought to benefit from early palliative care. Patients in the INTEGRATE Intervention Group were 1:1 matched to controls selected from provincial healthcare administrative data using propensity score-matching. The use of palliative care, community-based care services (home care, physician home visit, and outpatient opioid use) and acute care (emergency department, hospitalization) was each evaluated within one year after the date of identification. The hazard ratio (HR) in the Intervention Group was calculated for each outcome.ResultsOf the 1,185 patients in the Intervention Group, 951 (80.3%) used palliative care services during follow-up, compared to 739 (62.4%) among 1,185 patients in the Control Group [HR of 1.69 (95% CI 1.56 to 1.82)]. The Intervention Group also had higher proportions of patients who used home care [81.4% vs. 55.2%; HR 2.07 (95% CI 1.89 to 2.27)], had physician home visits [35.5% vs. 23.7%; HR 1.63 (95% CI 1.46 to 1.92)] or had increased outpatient opioid use [64.3% vs. 52.1%); HR 1.43 (95% CI 1.30 to 1.57]. The Intervention Group was also more likely to have a hospitalization that was not primarily focused on palliative care (1.42 (95% CI 1.28 to 1.58)) and an unplanned emergency department visit for non-palliative care purpose (1.47 (95% CI 1.32 to 1.64)).ConclusionPhysicians actively identifying patients who would benefit from palliative care resulted in increased use of palliative and community-based care services, but also increased use of acute care services.

Highlights

  • Palliative care is focused on managing the physical, psychosocial, and spiritual needs of patients with life-threatening illnesses [1]

  • Of the 1,185 patients in the Intervention Group, 951 (80.3%) used palliative care services during follow-up, compared to 739 (62.4%) among 1,185 patients in the Control Group [hazard ratio (HR) of 1.69]

  • The Intervention Group had higher proportions of patients who used home care [81.4% vs. 55.2%; HR 2.07], had physician home visits [35.5% vs. 23.7%; HR 1.63] or had increased outpatient opioid use [64.3% vs. 52.1%); HR 1.43

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Summary

Introduction

Palliative care is focused on managing the physical, psychosocial, and spiritual needs of patients with life-threatening illnesses [1]. Identification of patients who may benefit from a palliative approach to care has led to improved clinical outcomes, symptom control, quality of life and more efficient target use of health system resources across different populations of cancer patients [2,3,4,5,6]. Despite evidence of improved clinical outcomes for early identification of patients who would benefit form palliative care services, there is limited information on whether this early identification leads to earlier palliative care involvement and if so, how early in the trajectory. There is limited information about the use of community-based care for such patients. Our objective was to examine the palliative, community-based services and acute services used by those actively identified as patients that would benefit from a palliative care services.

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