Earlier initiation of community-based palliative care is associated with fewer unplanned hospitalisations and emergency department presentations in the final months of life: a population-based study amongst cancer decedents.

Abstract

CONTEXT: While community-based palliative care (CPC) is associated with decreased acute care use in the lead up to death, it is unclear how the timing of CPC initiation affects this association. OBJECTIVES: We aimed to explore the association between timing of CPC initiation and hospital use, over the final 1, 3, 6 and 12 months of life. METHODS: We conducted a retrospective, population-based study in Perth, Western Australia. Linked administrative data including cancer registry, mortality, hospital admissions, emergency department (ED) and CPC records were obtained for cancer decedents from 1 January 2001 to 31 December 2011. The exposure was month of CPC initiation; outcomes were unplanned hospitalisations, emergency department (ED) presentations and associated costs. RESULTS: Of 28,331 decedents residing in the CPC catchment area, 16,439 (58%) accessed CPC, mostly (64%) in the last three months of life. Initiation of CPC prior to the last six months of life was associated with a lower mean rate of unplanned hospitalisations in the last six months of life (1.4 versus 1.7 for initiation within six months of death); associated costs were also lower ($(A2012) 12,976 versus $13,959, comparing the same groups). However, those initiating CPC earlier did show a trend towards longer time in hospital when admitted, compared to those initiating in the final month of life. CONCLUSIONS: When viewed at a population-level, these results argue against temporally restricting access to CPC, as earlier initiation may pay dividends in the final few months of life in terms of fewer unplanned hospitalisations and ED presentations.