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Improved quality of care and reduced healthcare costs at the end-of-life among older people with dementia who received palliative home care : a nationwide propensity score-matched decedent cohort study

Rose Miranda (UGent) , Tinne Smets (UGent) , Robrecht De Schreye, Kristof Faes, Nele Van Den Noortgate (UGent) , Joachim Cohen (UGent) and Lieve Van den Block (UGent)
(2021) PALLIATIVE MEDICINE. 35(9). p.1701-1712
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Abstract
Background: While palliative home care is advocated for people with dementia, evidence of its effectiveness is lacking. Aim: To evaluate the effects of palliative home care on quality and costs of end-of-life care for older people with dementia. Design: Decedent cohort study using linked nationwide administrative databases and propensity score matching. Setting/participants: All home-dwelling older people who died with dementia between 2010 and 2015 in Belgium (N = 23,670). Exposure: Receiving palliative home care support for the first time between 360 and 15 days before death. Results: Five thousand six hundred and thirty-seven (23.8%) received palliative home care support in the last 2 years of life, of whom 2918 received it for the first time between 360 and 15 days before death. Two thousand eight hundred and thirty-nine people who received support were matched to 2839 people who received usual care. After matching, those using palliative home care support, in the last 14 days of life, had lower risk of hospital admission (17.5% vs 50.5%; relative risk (RR) = 0.21), undergoing diagnostic testing (17.0% vs 53.6%; RR = 0.20) and receiving inappropriate medications, but were more likely to die at home (75.7% vs 32.6%; RR = 6.45) and to have primary care professional contacts (mean 11.7 vs mean 5.2), compared with those who did not. Further, they had lower mean total costs of care in the last 30 days of life (incremental cost:-euro2129). Conclusions: Palliative home care use by home-dwelling older people with dementia is associated with improved quality and reduced costs of end-of-life care. Access remains low and should be increased.
Keywords
Anesthesiology and Pain Medicine, General Medicine, Palliative care, terminal care, end of life care, dementia, home care services, big data, BIG DATA, BARRIERS, FACILITATORS, CHALLENGES, DATABASES, HISTORY, DISEASE

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MLA
Miranda, Rose, et al. “Improved Quality of Care and Reduced Healthcare Costs at the End-of-Life among Older People with Dementia Who Received Palliative Home Care : A Nationwide Propensity Score-Matched Decedent Cohort Study.” PALLIATIVE MEDICINE, vol. 35, no. 9, 2021, pp. 1701–12, doi:10.1177/02692163211019321.
APA
Miranda, R., Smets, T., De Schreye, R., Faes, K., Van Den Noortgate, N., Cohen, J., & Van den Block, L. (2021). Improved quality of care and reduced healthcare costs at the end-of-life among older people with dementia who received palliative home care : a nationwide propensity score-matched decedent cohort study. PALLIATIVE MEDICINE, 35(9), 1701–1712. https://doi.org/10.1177/02692163211019321
Chicago author-date
Miranda, Rose, Tinne Smets, Robrecht De Schreye, Kristof Faes, Nele Van Den Noortgate, Joachim Cohen, and Lieve Van den Block. 2021. “Improved Quality of Care and Reduced Healthcare Costs at the End-of-Life among Older People with Dementia Who Received Palliative Home Care : A Nationwide Propensity Score-Matched Decedent Cohort Study.” PALLIATIVE MEDICINE 35 (9): 1701–12. https://doi.org/10.1177/02692163211019321.
Chicago author-date (all authors)
Miranda, Rose, Tinne Smets, Robrecht De Schreye, Kristof Faes, Nele Van Den Noortgate, Joachim Cohen, and Lieve Van den Block. 2021. “Improved Quality of Care and Reduced Healthcare Costs at the End-of-Life among Older People with Dementia Who Received Palliative Home Care : A Nationwide Propensity Score-Matched Decedent Cohort Study.” PALLIATIVE MEDICINE 35 (9): 1701–1712. doi:10.1177/02692163211019321.
Vancouver
1.
Miranda R, Smets T, De Schreye R, Faes K, Van Den Noortgate N, Cohen J, et al. Improved quality of care and reduced healthcare costs at the end-of-life among older people with dementia who received palliative home care : a nationwide propensity score-matched decedent cohort study. PALLIATIVE MEDICINE. 2021;35(9):1701–12.
IEEE
[1]
R. Miranda et al., “Improved quality of care and reduced healthcare costs at the end-of-life among older people with dementia who received palliative home care : a nationwide propensity score-matched decedent cohort study,” PALLIATIVE MEDICINE, vol. 35, no. 9, pp. 1701–1712, 2021.
@article{8712060,
  abstract     = {{Background: While palliative home care is advocated for people with dementia, evidence of its effectiveness is lacking. Aim: To evaluate the effects of palliative home care on quality and costs of end-of-life care for older people with dementia. Design: Decedent cohort study using linked nationwide administrative databases and propensity score matching. Setting/participants: All home-dwelling older people who died with dementia between 2010 and 2015 in Belgium (N = 23,670). Exposure: Receiving palliative home care support for the first time between 360 and 15 days before death. Results: Five thousand six hundred and thirty-seven (23.8%) received palliative home care support in the last 2 years of life, of whom 2918 received it for the first time between 360 and 15 days before death. Two thousand eight hundred and thirty-nine people who received support were matched to 2839 people who received usual care. After matching, those using palliative home care support, in the last 14 days of life, had lower risk of hospital admission (17.5% vs 50.5%; relative risk (RR) = 0.21), undergoing diagnostic testing (17.0% vs 53.6%; RR = 0.20) and receiving inappropriate medications, but were more likely to die at home (75.7% vs 32.6%; RR = 6.45) and to have primary care professional contacts (mean 11.7 vs mean 5.2), compared with those who did not. Further, they had lower mean total costs of care in the last 30 days of life (incremental cost:-euro2129). Conclusions: Palliative home care use by home-dwelling older people with dementia is associated with improved quality and reduced costs of end-of-life care. Access remains low and should be increased.}},
  articleno    = {{02692163211019321}},
  author       = {{Miranda, Rose and Smets, Tinne and De Schreye, Robrecht and Faes, Kristof and Van Den Noortgate, Nele and Cohen, Joachim and Van den Block, Lieve}},
  issn         = {{0269-2163}},
  journal      = {{PALLIATIVE MEDICINE}},
  keywords     = {{Anesthesiology and Pain Medicine,General Medicine,Palliative care,terminal care,end of life care,dementia,home care services,big data,BIG DATA,BARRIERS,FACILITATORS,CHALLENGES,DATABASES,HISTORY,DISEASE}},
  language     = {{eng}},
  number       = {{9}},
  pages        = {{02692163211019321:1701--02692163211019321:1712}},
  title        = {{Improved quality of care and reduced healthcare costs at the end-of-life among older people with dementia who received palliative home care : a nationwide propensity score-matched decedent cohort study}},
  url          = {{http://doi.org/10.1177/02692163211019321}},
  volume       = {{35}},
  year         = {{2021}},
}
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