• X A Chitnis, T Georghiou, A Steventon, and M J Bardsley.
• Director of Research, The Nuffield Trust, London, UK.
• BMJ Support Palliat Care. 2013 Dec 1;3(4):422-30.

ObjectiveTo assess the effect of routinely delivered home-based end-of-life care on hospital use at the end of life and place of death.DesignRetrospective analysis using matched controls and administrative data.SettingCommunity-based care in England.Participants29,538 people aged over 18 who received Marie Curie nursing support compared with 29,538 controls individually matched on variables including: age, socioeconomic deprivation, prior hospital use, number of chronic conditions and prior diagnostic history.InterventionHome-based end-of-life nursing care delivered by the Marie Curie Nursing Service (MCNS), compared with end-of-life care available to those who did not receive MCNS care.Main Outcome MeasuresProportion of people who died at home; numbers of emergency and elective inpatient admissions, outpatient attendances and attendances at emergency departments in the period until death; and notional costs of hospital care.ResultsIntervention patients were significantly more likely to die at home and less likely to die in hospital than matched controls (unadjusted OR 6.16, 95% CI 5.94 to 6.38, p<0.001). Hospital activity was significantly lower among intervention than matched control patients (emergency admissions: 0.14 vs 0.44 admissions per person, p<0.001) and average costs across all hospital services were lower (unadjusted average costs per person, £610 (intervention patients) vs £1750 (matched controls), p<0.001). Greater activity and cost differences were seen in those patients who had been receiving home nursing for longer.ConclusionsHome-based end-of-life care offers the potential to reduce demand for acute hospital care and increase the number of people able to die at home.

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