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Does early palliative identification improve the use of palliative care services?
PURPOSE: To evaluate whether the early identification of patients who may benefit from palliative care impacts on the use of palliative, community and acute-based care services. METHODS: Between 2014 and 2017, physicians from eight sites were encouraged to systematically identify patients who were l...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6994244/ https://www.ncbi.nlm.nih.gov/pubmed/32005036 http://dx.doi.org/10.1371/journal.pone.0226597 |
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author | Mittmann, Nicole Liu, Ning MacKinnon, Marnie Seung, Soo Jin Look Hong, Nicole J. Earle, Craig C. Gradin, Sharon Sati, Saurabh Buchman, Sandy Jakda, Ahmed Wright, Frances C. |
author_facet | Mittmann, Nicole Liu, Ning MacKinnon, Marnie Seung, Soo Jin Look Hong, Nicole J. Earle, Craig C. Gradin, Sharon Sati, Saurabh Buchman, Sandy Jakda, Ahmed Wright, Frances C. |
author_sort | Mittmann, Nicole |
collection | PubMed |
description | PURPOSE: To evaluate whether the early identification of patients who may benefit from palliative care impacts on the use of palliative, community and acute-based care services. METHODS: Between 2014 and 2017, physicians from eight sites were encouraged to systematically identify patients who were likely to die within one year and would were thought to benefit from early palliative care. Patients in the INTEGRATE Intervention Group were 1:1 matched to controls selected from provincial healthcare administrative data using propensity score-matching. The use of palliative care, community-based care services (home care, physician home visit, and outpatient opioid use) and acute care (emergency department, hospitalization) was each evaluated within one year after the date of identification. The hazard ratio (HR) in the Intervention Group was calculated for each outcome. RESULTS: Of the 1,185 patients in the Intervention Group, 951 (80.3%) used palliative care services during follow-up, compared to 739 (62.4%) among 1,185 patients in the Control Group [HR of 1.69 (95% CI 1.56 to 1.82)]. The Intervention Group also had higher proportions of patients who used home care [81.4% vs. 55.2%; HR 2.07 (95% CI 1.89 to 2.27)], had physician home visits [35.5% vs. 23.7%; HR 1.63 (95% CI 1.46 to 1.92)] or had increased outpatient opioid use [64.3% vs. 52.1%); HR 1.43 (95% CI 1.30 to 1.57]. The Intervention Group was also more likely to have a hospitalization that was not primarily focused on palliative care (1.42 (95% CI 1.28 to 1.58)) and an unplanned emergency department visit for non-palliative care purpose (1.47 (95% CI 1.32 to 1.64)). CONCLUSION: Physicians actively identifying patients who would benefit from palliative care resulted in increased use of palliative and community-based care services, but also increased use of acute care services. |
format | Online Article Text |
id | pubmed-6994244 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-69942442020-02-20 Does early palliative identification improve the use of palliative care services? Mittmann, Nicole Liu, Ning MacKinnon, Marnie Seung, Soo Jin Look Hong, Nicole J. Earle, Craig C. Gradin, Sharon Sati, Saurabh Buchman, Sandy Jakda, Ahmed Wright, Frances C. PLoS One Research Article PURPOSE: To evaluate whether the early identification of patients who may benefit from palliative care impacts on the use of palliative, community and acute-based care services. METHODS: Between 2014 and 2017, physicians from eight sites were encouraged to systematically identify patients who were likely to die within one year and would were thought to benefit from early palliative care. Patients in the INTEGRATE Intervention Group were 1:1 matched to controls selected from provincial healthcare administrative data using propensity score-matching. The use of palliative care, community-based care services (home care, physician home visit, and outpatient opioid use) and acute care (emergency department, hospitalization) was each evaluated within one year after the date of identification. The hazard ratio (HR) in the Intervention Group was calculated for each outcome. RESULTS: Of the 1,185 patients in the Intervention Group, 951 (80.3%) used palliative care services during follow-up, compared to 739 (62.4%) among 1,185 patients in the Control Group [HR of 1.69 (95% CI 1.56 to 1.82)]. The Intervention Group also had higher proportions of patients who used home care [81.4% vs. 55.2%; HR 2.07 (95% CI 1.89 to 2.27)], had physician home visits [35.5% vs. 23.7%; HR 1.63 (95% CI 1.46 to 1.92)] or had increased outpatient opioid use [64.3% vs. 52.1%); HR 1.43 (95% CI 1.30 to 1.57]. The Intervention Group was also more likely to have a hospitalization that was not primarily focused on palliative care (1.42 (95% CI 1.28 to 1.58)) and an unplanned emergency department visit for non-palliative care purpose (1.47 (95% CI 1.32 to 1.64)). CONCLUSION: Physicians actively identifying patients who would benefit from palliative care resulted in increased use of palliative and community-based care services, but also increased use of acute care services. Public Library of Science 2020-01-31 /pmc/articles/PMC6994244/ /pubmed/32005036 http://dx.doi.org/10.1371/journal.pone.0226597 Text en © 2020 Mittmann et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Mittmann, Nicole Liu, Ning MacKinnon, Marnie Seung, Soo Jin Look Hong, Nicole J. Earle, Craig C. Gradin, Sharon Sati, Saurabh Buchman, Sandy Jakda, Ahmed Wright, Frances C. Does early palliative identification improve the use of palliative care services? |
title | Does early palliative identification improve the use of palliative care services? |
title_full | Does early palliative identification improve the use of palliative care services? |
title_fullStr | Does early palliative identification improve the use of palliative care services? |
title_full_unstemmed | Does early palliative identification improve the use of palliative care services? |
title_short | Does early palliative identification improve the use of palliative care services? |
title_sort | does early palliative identification improve the use of palliative care services? |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6994244/ https://www.ncbi.nlm.nih.gov/pubmed/32005036 http://dx.doi.org/10.1371/journal.pone.0226597 |
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