Predictors of Place of Death Among Patients in a Home-Based Primary Care Program (SA510-B)

Abstract

1.Understand the role of home-based primary care in facilitating place of death.2.Understand the literature regarding predictors of home death. Studies show that although most people would prefer to die at home, at least two-thirds die in an institutional setting. The Mount Sinai Visiting Doctors Program (MSVD), a home-based primary care (HBPC) model, treats more than1,000 homebound patients in Manhattan. There has not yet been an in-depth analysis of care in the last month of life in HBPC and how symptoms, frequency of visits, and demographic characteristics influence place of death. To determine predictors of location of death in HBPC. We performed retrospective chart reviews of all 189 MSVD patients who died in 2012. Six patients (3.17%) died in nursing homes and were excluded because we could not access their care patterns. Of the remaining 183 patients, 52 (28.42%) died in the hospital and 131 (71.58%) died outside the hospital—103 (56.28%) at home and 28 (15.30%) in inpatient hospice. Forty-six (25.14%) were male, 161 (90.45%) had do not resuscitate (DNR) orders, 88 (48.35%) had outpatient hospice, 102 (55.74%) had Medicaid, and 25 (13.81%) lived alone. Non-hospital death was more common for White patients (P<0.001), patients≥90 years of age (P=0.021), those in home hospice (P<0.001), and those with a documented preference not to be hospitalized (P=0.036). There was no statistically significant association between the likelihood of home death and functional status at enrollment; the number of home visits in the last month; presence of a caregiver; living alone; and dementia, cancer, stroke, or heart or lung disease. Our results suggest that HBPC facilitates a frequency of home death far above the national average. Even with the support offered by HBPC, socioeconomic status, ethnicity, and age play a role in predicting place of death. HBPC can help meet patients' wishes regarding place of death, irrespective of comorbidities and whether the patient lives alone, and highlights the importance of addressing this issue with patients and caregivers.