A Comparison of the Survival, Place of Death, and Medical Utilization of Terminal Patients Receiving Hospital-Based and Community-Based Palliative Home Care: A Retrospective and Propensity Score Matching Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Study Population and Settings
2.3. Group Allocation Process
2.4. Data Sources and Data Collection
2.5. Data Analysis
2.6. Ethical Consideration
3. Results
3.1. Participant Characteristics
3.2. Medical Utilization, Place of Death, and Survival Days
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | Palliative Home Care Type (Before PSM) | p-Value | Palliative Home Care Type (After PSM) | p-Value | ||
---|---|---|---|---|---|---|
Hospital (n = 131) | Community (n = 43) | Hospital (n = 42) | Community (n = 42) | |||
N (%)/Mean ± SD | N (%)/Mean ± SD | |||||
Age | 74.38 ± 12.30 | 72.14 ± 12.81 | 0.31 | 71.33 ± 13.46 | 72.31 ± 12.92 | 0.74 |
Gender | 0.60 | 0.66 | ||||
Female | 79 (60.3%) | 24 (55.8%) | 22 (52.4%) | 24 (57.1%) | ||
Male | 52 (39.7%) | 19 (44.2%) | 20 (47.6%) | 18 (42.9%) | ||
Education | 0.99 | 0.52 | ||||
≦6 years | 70 (53.4%) | 23 (53.5%) | 18 (42.9%) | 23 (54.8%) | ||
7~12 years | 49 (37.4%) | 16 (37.2%) | 20 (47.6%) | 15 (35.7%) | ||
>12 years | 12 (9.2%) | 4 (9.3%) | 4 (9.5%) | 4 (9.5%) | ||
Marriage | 0.98 | 0.47 | ||||
Single | 8 (6.1%) | 2 (4.7%) | 3 (7.1%) | 2 (4.8%) | ||
Married | 68 (51.9%) | 22 (51.2%) | 27 (64.3%) | 21 (50.0%) | ||
Widowed | 47 (35.9%) | 16 (37.20%) | 10 (23.8%) | 16 (38.1%) | ||
Separated/ Divorced | 8 (6.1%) | 3 (7.0%) | 2 (4.8%) | 3 (7.1%) | ||
Religion | 0.37 | 0.72 | ||||
None | 33 (25.2%) | 10 (23.3%) | 12 (28.6%) | 10 (23.8%) | ||
Buddhism | 43 (32.8%) | 12 (27.9%) | 12 (28.6%) | 12 (28.6%) | ||
Christianity | 10 (7.6%) | 2 (4.7%) | 4 (9.5%) | 2 (4.8%) | ||
Taoism/Folk religion | 45 (34.4%) | 18 (41.9%) | 14 (33.3%) | 18 (42.9%) | ||
Other | 0 (0%) | 1 (2.3%) | 0 (0%) | 0 (0%) | ||
ECOG | 0.23 | 0.25 | ||||
2 | 1 (0.8%) | 2 (4.7%) | 0 (0%) | 2 (4.8%) | ||
3 | 66 (50.4%) | 20 (46.5%) | 24 (57.1%) | 19 (45.2%) | ||
4 | 64 (48.9%) | 21 (48.8%) | 18 (42.9%) | 21 (50%) | ||
Terminal Diagnosis | 0.64 | 0.99 | ||||
Cancer | 117 (89.3%) | 42 (97.7%) | 41 (97.6%) | 41 (97.6%) | ||
Brain disease | 7 (5.3%) | 1 (2.3%) | 1 (2.4%) | 1 (2.4%) | ||
Organ failure | 6 (4.6%) | 0 (0%) | 0 (0%) | 0 (0%) | ||
ALS | 1 (0.8%) | 0 (0%) | 0 (0%) | 0 (0%) | ||
Devices/Wounds/Infusion 1 | ||||||
Nasogastric tube | 41 (31.3%) | 12 (27.9%) | 0.68 | 10 (23.8%) | 12 (28.6%) | 0.62 |
Foley tube | 51 (38.9%) | 15 (34.9%) | 0.64 | 17 (40.5%) | 15 (35.7%) | 0.65 |
Tracheostomy | 3 (2.3%) | 1 (2.3%) | 0.99 | 1 (2.4%) | 1 (2.4%) | 0.99 |
Gastro-/Jejunostomy | 6 (4.6%) | 3 (7.0%) | 0.69 | 2 (4.8%) | 3 (7.1%) | 0.99 |
Colostomy | 13 (9.9%) | 3 (7.0%) | 0.76 | 3 (7.1%) | 3 (7.1%) | 0.99 |
Intravenous Fluid | 8 (6.1%) | 0 (0%) | 0.20 | 3 (7.1%) | 0 (0%) | 0.24 |
Wound | 42 (32.1%) | 14 (32.6%) | 0.95 | 13 (31.0%) | 14 (33.3%) | 0.82 |
Distance from nursing institution to patient’s home (km) | 3.92 ± 2.12 | 8.21 ± 5.23 | <0.01 | 3.71 ± 1.92 | 7.90 ± 4.86 | <0.01 |
Distance from hospital to patient’s home (km) | 3.92 ± 2.23 | 9.29 ± 7.35 | <0.01 | 3.71 ± 1.92 | 8.72 ± 6.39 | <0.01 |
Variables | Palliative Home Care Type (Before PSM) | p-Value | Palliative Home Care Type (After PSM) | p-Value | ||
---|---|---|---|---|---|---|
Hospital (n = 131) | Community (n = 43) | Hospital (n = 42) | Community (n = 42) | |||
N (%)/Mean ± SD | N (%)/Mean ± SD | |||||
Number of physician visits | 5.18 ± 5.46 | 3.09 ± 2.39 | <0.01 | 5.17 ± 6.56 | 3.14 ± 2.40 | 0.07 |
Physician visit interval (day/time) | 15.59± 9.40 | 18.28 ± 15.63 | 0.29 | 15.00 ± 9.32 | 18.6 ± 15.61 | 0.20 |
Number of nurse visits | 5.91 ± 5.93 | 9.98 ± 9.97 | 0.01 | 5.57 ± 6.95 | 10.19 ± 9.99 | 0.02 |
Nurse visit interval (day/time) | 13.07± 8.66 | 6.30 ± 3.65 | <0.01 | 14.19 ± 9.25 | 6.40 ± 3.63 | <0.01 |
Total days of care | 82.12 ± 95.38 | 61.30 ± 64.40 | 0.18 | 71.76 ± 95.5 | 62.71 ± 64.5 | 0.61 |
The wait time between referral and acceptance to PHC | 9.53 ± 5.87 | 6.47 ± 5.41 | <0.01 | 9.45 ± 6.43 | 6.40 ± 5.46 | 0.02 |
Ever been to ED after referred to PHC but not yet received PHC | 0.06 | 0.04 | ||||
Yes | 21 (16%) | 2 (4.7%) | 8 (19.0%) | 2 (4.8%) | ||
No | 110 (84%) | 41 (95.3%) | 34 (81.0%) | 40 (95.2%) | ||
The total number of ED visits after referred to PHC but not yet received PHC | 0.18 ± 0.420 | 0.07 ± 0.33 | 0.10 | 0.21 ± 0.47 | 0.07 ± 0.34 | 0.12 |
Ever been to the ED | 0.049 | 0.01 | ||||
Yes | 86 (65.6%) | 21 (48.8%) | 31 (73.8%) | 20 (47.6%) | ||
No | 45 (34.4%) | 22 (51.2%) | 11 (26.2%) | 22 (52.4%) | ||
Number of ED visits | 0.90 ± 0.927 | 0.58 ± 0.698 | 0.04 | 1.07 ±0.92 | 0.57 ±0.70 | <0.01 |
Ever been hospitalized | 0.73 | 0.36 | ||||
Yes | 80 (61.1%) | 25 (58.1%) | 29 (69.0%) | 25 (59.5%) | ||
No | 51 (38.9%) | 18 (41.9%) | 13 (31.0%) | 17 (40.5%) | ||
Number of hospitalizations | 0.78 ± 0.797 | 0.77 ± 0.782 | 0.94 | 0.90 ± 0.85 | 0.79 ± 0.72 | 0.51 |
The total length of hospital stays | 9.92 ± 13.59 | 7.23 ± 10.71 | 0.24 | 10.40 ± 12.54 | 7.40 ± 10.78 | 0.24 |
The average length of hospital stay | 7.84 ± 10.12 | 5.03 ± 6.12 | 0.03 | 8.42 ± 10.32 | 5.15 ± 6.14 | 0.08 |
Place of death | 0.13 | 0.02 | ||||
Home | 47 (35.9%) | 22 (51.2%) | 12 (28.6%) | 22 (52.4%) | ||
Nursing/residential home | 8 (6.1%) | 1 (2.3%) | 3 (7.1%) | 1 (2.4%) | ||
Palliative care unit/inpatient hospice | 63 (48.1%) | 16 (37.2%) | 24 (57.1%) | 16 (38.1%) | ||
General wards | 3 (2.3%) | 3 (7.0%) | 0 (0%) | 3 (7.1%) | ||
Emergency department | 10 (7.6%) | 1 (2.3%) | 3 (7.1%) | 0 (0%) |
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Lin, C.-P.; Tsay, M.-S.; Chang, Y.-H.; Chen, H.-C.; Wang, C.-Y.; Chuang, Y.-S.; Wu, C.-Y. A Comparison of the Survival, Place of Death, and Medical Utilization of Terminal Patients Receiving Hospital-Based and Community-Based Palliative Home Care: A Retrospective and Propensity Score Matching Cohort Study. Int. J. Environ. Res. Public Health 2021, 18, 7272. https://doi.org/10.3390/ijerph18147272
Lin C-P, Tsay M-S, Chang Y-H, Chen H-C, Wang C-Y, Chuang Y-S, Wu C-Y. A Comparison of the Survival, Place of Death, and Medical Utilization of Terminal Patients Receiving Hospital-Based and Community-Based Palliative Home Care: A Retrospective and Propensity Score Matching Cohort Study. International Journal of Environmental Research and Public Health. 2021; 18(14):7272. https://doi.org/10.3390/ijerph18147272
Chicago/Turabian StyleLin, Cheng-Pei, Min-Shiow Tsay, Yi-Hui Chang, Hung-Cheng Chen, Ching-Yu Wang, Yun-Shiuan Chuang, and Chien-Yi Wu. 2021. "A Comparison of the Survival, Place of Death, and Medical Utilization of Terminal Patients Receiving Hospital-Based and Community-Based Palliative Home Care: A Retrospective and Propensity Score Matching Cohort Study" International Journal of Environmental Research and Public Health 18, no. 14: 7272. https://doi.org/10.3390/ijerph18147272