Abstract
BackgroundCurrent policies recommend integrating home care and palliative care to enable patients to remain at home and avoid unnecessary hospital admission and emergency department (ED) visits. The Italian health care system had implemented integrated palliative home care (IHPC) services to guarantee a comprehensive, coordinated approach across different actors and to reduce potentially avoidable ED visits. This study aimed to analyze the trajectories of ED visit rates among patients receiving IHPC in the Italian healthcare system, as well as the association between socio-demographic, health supply, and clinical factors.MethodsA pooled, cross-sectional, time series analysis was performed in a large Italian region in the period 2013–2017. Data were taken from two databases of the official Italian National Information System: Home Care Services and ED use. A clinical record is opened at the time a patient is enrolled in IHPC and closed after the last service is provided. Every such clinical record was considered as an IHPC event, and only ED visits that occurred during IHPC events were considered.ResultsThe 20,611 patients enrolled in IHPC during the study period contributed 23,085 IHPC events; ≥1 ED visit occurred during 6046 of these events. Neoplasms accounted for 89% of IHPC events and for 91% of ED visits. Although there were different variations in ED visit rates during the study period, a slight decline was observed for all diseases, and this decline accelerated over time (b = − 0.18, p = 0.796, 95% confidence interval [CI] = − 1.59;1.22, b-squared = − 1.25, p < 0.001, 95% CI = -1.63;-0.86). There were no significant predictors among the socio-demographic factors (sex, age, presence of a non-family caregiver, cohabitant family members, distance from ED), health supply factors (proponent of IHPC) and clinical factors (prevalent disorder at IHPC entry, clinical symptoms).ConclusionOur results show that use of ED continues after enrollment in IHPC, but the trend of this use declines over time. As no significant predictive factors were identified, no specific interventions can be recommended on which the avoidable ED visits depend.
Highlights
Current policies recommend integrating home care and palliative care to enable patients to remain at home and avoid unnecessary hospital admission and emergency department (ED) visits
A total of 20,611 patients were enrolled in Integrated palliative home care (IHPC) during the study period (2013–2017), and they contributed 23, 085 IHPC events
Stratification by pathology at IHPC entry shows that most IHPC events were carried out for patients with neoplasms
Summary
Home care represents the best response to epidemiological changes in the population (aging, increased comorbidity, and chronic pathologies) and the economic sustainability of national healthcare services [1] This is true for the delivery of palliative care, the goal of which is to prevent and relieve suffering and provide the best possible quality of life to patients and their families, regardless of their stage of illness [2, 3]. IHPC requires the creation of an individual care plan, the purpose of which is to identify the goals of care and the most appropriate interventions in case of problems This plan is prepared by the multi-professional team and must be shared with the patient and their family and/or caregiver, as it constitutes a therapeutic care contract.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
