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BMJ Support Palliat Care. 2013 Dec;3(4):422-30. doi: 10.1136/bmjspcare-2012-000424. Epub 2013 Jun 6.

Effect of a home-based end-of-life nursing service on hospital use at the end of life and place of death: a study using administrative data and matched controls.

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1
Director of Research, The Nuffield Trust, London, UK.

Abstract

OBJECTIVE:

To assess the effect of routinely delivered home-based end-of-life care on hospital use at the end of life and place of death.

DESIGN:

Retrospective analysis using matched controls and administrative data.

SETTING:

Community-based care in England.

PARTICIPANTS:

29,538 people aged over 18 who received Marie Curie nursing support compared with 29,538 controls individually matched on variables including: age, socioeconomic deprivation, prior hospital use, number of chronic conditions and prior diagnostic history.

INTERVENTION:

Home-based end-of-life nursing care delivered by the Marie Curie Nursing Service (MCNS), compared with end-of-life care available to those who did not receive MCNS care.

MAIN OUTCOME MEASURES:

Proportion of people who died at home; numbers of emergency and elective inpatient admissions, outpatient attendances and attendances at emergency departments in the period until death; and notional costs of hospital care.

RESULTS:

Intervention patients were significantly more likely to die at home and less likely to die in hospital than matched controls (unadjusted OR 6.16, 95% CI 5.94 to 6.38, p<0.001). Hospital activity was significantly lower among intervention than matched control patients (emergency admissions: 0.14 vs 0.44 admissions per person, p<0.001) and average costs across all hospital services were lower (unadjusted average costs per person, £610 (intervention patients) vs £1750 (matched controls), p<0.001). Greater activity and cost differences were seen in those patients who had been receiving home nursing for longer.

CONCLUSIONS:

Home-based end-of-life care offers the potential to reduce demand for acute hospital care and increase the number of people able to die at home.

KEYWORDS:

Home care; Hospital care; Terminal care

PMID:
24950522
DOI:
10.1136/bmjspcare-2012-000424
[Indexed for MEDLINE]
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