Intensity of integrated cancer palliative care plans and end-of-life acute medical hospitalisation among cancer patient in Northern Italy.

A high hospital utilisation at the end of life (EOL) is an indicator of suboptimal quality of health care. We evaluated the impact of the intensity of different Integrated Cancer Palliative Care (ICPC) plans on EOL acute medical hospitalisation among cancer decedents. Decedents of cancer aged 18-84 years, who were residents in two Italian regions, were investigated through integrated administrative data. Outcomes considered were prolonged hospital stay for medical reasons, 2+ hospitalisations during the last month of life and hospital death. The ICPC plans instituted 90 to 31 days before death represented the main exposure of interest. Other variables considered were gender, age class at death, marital status, recent hospitalisation and primary cancer site. Among 6,698 patients included in ICPC plans, 44.3% presented at least one critical outcome indicator; among these, 76.5% died in hospital, 60.3% had a prolonged (12+ days) medical hospitalisation, 19.1% had 2+ hospitalisations at the EOL. These outcomes showed a strong dose-response effect with the intensity of the ICPC plans, which is already evident at levels of moderate intensity. A well-ICPC approach can be very effective-beginning at low levels of intensity of care-in reducing the percentage of patients spending many days or dying in hospital.

Intensity of Integrated Primary and Specialist Home-Based Palliative Care for Chronic Diseases in Northeast Italy and Its Impact on End-of-Life Hospital Access.

BACKGROUND: Hospital admissions at the end of life (EOL) represent an established indicator of poor quality of care. OBJECTIVE: To examine the impact of intensity of integrated primary and specialist home-based palliative care for chronic diseases (HPCCD) plans of care on EOL hospital access. METHODS: Retrospective population-based study using linked mortality, hospitalization, and home care data. Intensity of HPCCD was measured 90-31 days before death; outcomes were hospital death and prolonged hospital stay for medical reasons in the last month of life. Outcomes were modeled through Poisson and quartile regressions. Adults aged 65-84 years with at least an ordinary hospitalization and a drug treatment in the year before death, who died from nononcological chronic diseases in the Veneto Region, January 2012-December 2013, were included. RESULTS: Among 2087 patients, 1016 (48.7%) did not receive any HPCCD homecare visit; 860 (41.2%), 152 (7.3%), and 59 (2.8%) had <2, 2-4, and 4-7 homecare visits/week, respectively. Hospital death occurred for 1310 patients (62.8%) and the median hospital stay in the last month of life was five days (interquartile range 0-14). In multivariate analysis, a higher intensity of HPCCD was associated with lower rates of prolonged (≥14 days) EOL hospitalization and hospital death with a dose-response relationship. When no access to HPCCD was compared with 2-4 visits/week, adjusted percentage of hospital death decreased by -18.4% (95% confidence interval [CI] -5.4% to -29.7%) and the length of hospital stay decreased by 37.9% (95% CI 16.7%-56.0%). CONCLUSIONS: The intensity of integrated HPCCD plans of care was associated with a reduction in EOL hospital stay and in hospital death.