Home care services use has been proposed as a means of reducing costs in palliative care by decreasing hospital stay without impacting quality of clinical care; however, little is known about utilization of these services in the time following a terminal cancer diagnosis.
Aim:
To examine disease, patient and healthcare system predictors of hospital stay, and home care services use in metastatic gastric cancer patients.
Design:
This is a population-based, retrospective cohort study. Chart review and administrative data were linked, using a 26-month time horizon to collect health services data.
Participants:
All patients diagnosed with metastatic gastric cancer in the province of Ontario between 2005 and 2008 were included in the study (n = 1433).
Results:
Age, comorbidity, tumor location, and burden of metastatic disease were identified as predictors of hospital stay and receipt of home care services. Individuals who received home care services spent fewer days in hospital than individuals who did not (relative risk: 0.44; 95% confidence interval: 0.38–0.51). Patients who interacted with a high-volume oncology specialist had shorter cumulative hospital stay (relative risk: 0.62; 95% confidence interval: 0.54–0.71) and were less likely to receive home care services (relative risk: 0.80; 95% confidence interval: 0.72–0.88) than those who did not.
Conclusion:
Examining how differences in hospital stay and home care services use impact clinical outcomes and how policies may reduce costs to the healthcare system is necessary.
Canadian Institute for Health Information. The cost of acute care hospital stays by medical condition in Canada, 2004–2005, HCUP Statistical Brief #125, Rockville, MD. www.hcup-us.ahrq.gov/reports/statbriefs/sb125.jsp (February 2010).
5.
Anhang PriceRStrangesEElixhauserA. Cancer hospitalizations for adults, 2009. HCUP Statistical Brief #125, February2012.
BarberaLSussmanJViolaR. Factors associated with end-of-life health service use in patients dying of cancer. Healthc Policy2010; 5(3): e125–e143.
8.
BarberaLTaylorCDudgeonD.Why do patients with cancer visit the emergency department near the end of life?CMAJ2010; 182(6): 563–568.
9.
EarleCCParkERLaiB. Identifying potential indicators of the quality of end-of-life cancer care from administrative data. J Clin Oncol2003; 21(6): 1133–1138.
10.
LangtonJMBlanchBDrewAK. Retrospective studies of end-of-life resource utilization and costs in cancer care using health administrative data: a systematic review. Palliat Med. Epub ahead of print 27May2014. DOI: 10.1177/0269216314533813.
11.
De RooMLLeemansKClaessenSJ. Quality indicators for palliative care: update of a systematic review. J Pain Symptom Manage2013; 46(4): 556–572.
12.
SeowHBarberaLHowellD. How end-of-life home care services are used from admission to death: a population-based cohort study. J Palliat Care2010; 26(4): 270–278.
13.
EarleCCNevilleBALandrumMB. Trends in the aggressiveness of cancer care near the end of life. J Clin Oncol2004; 22(2): 315–321.
14.
JohnsonAPAbernathyTHowellD. Resource utilisation and costs of palliative cancer care in an interdisciplinary health care model. Palliat Med2009; 23(5): 448–459.
15.
SmithSBrickAO’HaraS. Evidence on the cost and cost-effectiveness of palliative care: a literature review. Palliat Med2014; 28(2): 130–150.
16.
ZimmermannCRiechelmannRKrzyzanowskaM. Effectiveness of specialized palliative care: a systematic review. JAMA2008; 299(14): 1698–1709.
17.
RiolfiMBujaAZanardoC. Effectiveness of palliative home-care services in reducing hospital admissions and determinants of hospitalization for terminally ill patients followed up by a palliative home-care team: a retrospective cohort study. Palliat Med2014; 28(5): 403–411.
18.
De OliveiraCBremnerKEPetakyR. Understanding the costs of cancer care before and after diagnosis in the 21 most common cancers in Ontario: a population-based descriptive study. CMAJ Open2013; 1: E1–E8.
19.
YabroffKRLamontEBMariottoA. Cost of care for elderly cancer patients in the United States. J Natl Cancer Inst2008; 100(9): 630–641.
20.
BachmannMOPetersTHarveyI.Costs and concentration of cancer care: evidence for pancreatic, oesophageal and gastric cancers in National Health Service hospitals. J Health Serv Res Policy2003; 8(2): 75–82.
Von ElmEAltmanDGEggerM. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol2008; 61(4): 344–349.
23.
WilliamsJIYoungW.A summary of studies on the quality of health care administrative databases in Canada. In: GoelVWilliamsJIAndersonGM. (eds) Patterns of health care in Ontario, the ICES practice atlas. 2nd ed.Ottawa, ON, Canada: Canadian Medical Association, 1996, pp.339–346.
24.
KraljB.Measuring “rurality” for purposes of health-care planning: an empirical measure for Ontario. Ontario Med Rev2000; 67: 33–52.
25.
MackillopWJZhang-SalomonsJGroomePA. Socioeconomic status and cancer survival in Ontario. J Clin Oncol1997; 15(4): 1680–1689.
26.
ReidRJRoosNPMacWilliamL. Assessing population health care need using a claims-based ACG morbidity measure: a validation analysis in the Province of Manitoba. Health Serv Res2002; 37(5): 1345–1364.
27.
MoineddinRMeaneyCAghaM. Modeling factors influencing the demand for emergency department services in Ontario: a comparison of methods. BMC Emerg Med2011; 11: 13.
28.
McNuttLAWuCXueX. Estimating the relative risk in cohort studies and clinical trials of common outcomes. Am J Epidemiol2003; 157(10): 940–943.
29.
Alonso-BabarroAAstray-MochalesJDominguez-BerjonF. The association between in-patient death, utilization of hospital resources and availability of palliative home care for cancer patients. Palliat Med2013; 27(1): 68–75.
30.
AnARLeeJKYunYH. Terminal cancer patients’ and their primary caregivers’ attitudes toward hospice/palliative care and their effects on actual utilization: a prospective cohort study. Palliat Med2014; 28(7): 976–985.
31.
CoburnNSeevaratnamRPaszatL. Optimal management of gastric cancer: results from an international RAND/UCLA expert panel. Ann Surg2014; 259: 102–108.
32.
AjaniJD’AmicoTAHaymanJA.; National Comprehensive Cancer Network. Gastric cancer. Clinical practice guidelines in oncology. J Natl Compr Canc Netw2003; 1(1): 28–39.
33.
SeowHBarberaLHowellD. Using more end-of-life homecare services is associated with using fewer acute care services: a population-based cohort study. Med Care2010; 48(2): 118–124.
34.
GrandeGEMcKerralAToddCJ.Which cancer patients are referred to Hospital at Home for palliative care?Palliat Med2002; 16(2): 115–123.
35.
MaharALCoburnNGSinghS. A systematic review of surgery for non-curative gastric cancer. Gastric Cancer2012; 15(1): S125–S137.
36.
LeeJAParkJHLeeEJ. High-quality, low-cost gastrectomy care at high-volume hospitals: results from a population-based study in South Korea. Arch Surg2011; 146(8): 930–936.
37.
BrarSSMaharALHelyerLK. Processes of care in the multidisciplinary treatment of gastric cancer: results of a RAND/UCLA expert panel. JAMA Surg2014; 149: 18–25.
