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    The Association of Community-Based Palliative Care With Reduced Emergency Department Visits in the Last Year of Life Varies by Patient Factors

    248095.pdf (329.4Kb)
    Access Status
    Open access
    Authors
    Spilsbury, Katrina
    Rosenwax, Lorna
    Arendts, G.
    Semmens, James
    Date
    2016
    Type
    Journal Article
    
    Metadata
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    Citation
    Spilsbury, K. and Rosenwax, L. and Arendts, G. and Semmens, J. 2016. The Association of Community-Based Palliative Care With Reduced Emergency Department Visits in the Last Year of Life Varies by Patient Factors. Annals of Emergency Medicine. 69 (4): pp. 416-425.
    Source Title
    Annals of Emergency Medicine
    DOI
    10.1016/j.annemergmed.2016.11.036
    ISSN
    0196-0644
    School
    Centre for Population Health Research
    School of Occupational Therapy and Social Work
    URI
    http://hdl.handle.net/20.500.11937/50999
    Collection
    • Curtin Research Publications
    Abstract

    Study objective: Palliative care has been shown to reduce end-of-life emergency department (ED) use. Our objective was to determine how the association of community-based palliative care with reduced ED visits in the last year of life varied by patient factors. Methods: This was a retrospective cohort study of 11,875 decedents who died with neoplasms, heart failure, renal failure, chronic obstructive pulmonary disease, or liver failure in Western Australia in 2009 to 2010. Outcome measures were adjusted hazard ratios (HRs) and daily (hazard) rates of ED visits. Results: The adjusted average rate of ED visits for the cohort was reduced 50% (HR 0.50; 95% confidence interval [CI] 0.47 to 0.53) during periods of receipt of community-based palliative care. This relative reduction in ED visits varied by patient factors, ranging from 43% (HR 0.57; 95% CI 0.45 to 0.74) for decedents aged 60 years and younger up to 71% (HR 0.29; 95% CI 0.18 to 0.46) for people aged 90 years and older. Decedents living in the most disadvantaged areas had a 44% (HR 0.56; 95% CI 0.44 to 0.72) reduction in ED visits when receiving community-based palliative care compared with a 60% (HR 0.40; 95% CI 0.31 to 0.53) reduction for decedents who lived in the least disadvantaged areas and received this care. The ED visit rates while patients were receiving palliative care also varied by ED visit history, partner status, and region of residence. Conclusion: Receipt of community-based palliative care in the last year of life was associated with a reduced rate of ED visits. The magnitude of this association was modified by patient health, as well as social and demographic factors. © 2016 American College of Emergency Physicians.

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