• Hsien Seow, Lisa Barbera, Doris Howell, and Sydney M Dy.
• Department of Oncology, McMaster University, Hamilton, Ontario, Canada. hsienseow@gmail.com
• Med Care. 2010 Feb 1;48(2):118-24.

BackgroundHealthcare systems are investing in end-of-life homecare to reduce acute care use. However, little evidence exists on the timing and amount of homecare services necessary to reduce acute care utilization.ObjectivesTo investigate whether admission time to homecare and the amount of services, as measured by average nursing and personal support and homemaking (PSH) hours/week (h/wk), are associated with using acute care services at end-of-life.Research DesignRetrospective observational cohort study.SubjectsDecedents admitted to end-of-life homecare in Ontario, Canada.MeasuresThe odds ratios (OR) of having a hospitalization or emergency room visit in the 2 weeks before death and dying in a hospital.ResultsThe cohort (n = 9018) used an average of 3.11 (SD = 4.87) nursing h/wk, 3.18 (SD = 6.89) PSH h/wk, and 18% were admitted to homecare for <1 month. As admission time to death and homecare services increased, the adjusted OR of an outcome decreased in a dose response manner. Patients admitted earlier than 6 months before death had a 35% (95% CI: 25%-44%) lower OR of hospitalization than those admitted 3 to 4 weeks before death; patients using more than 7 nursing h/wk and more than 7 PSH h/wk had a 50% (95% CI: 37%-60%) and 35% (95% CI: 21%-47%) lower OR of a hospitalization, respectively, than patients using 1 h/wk, controlling for other covariates. Other outcomes had similar results.ConclusionThese results suggest that early homecare admission and increased homecare services will help alleviate the demand for hospital resources at end-of-life.

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