Ontario health technology assessment series
-
Ont Health Technol Assess Ser · Jan 2014
ReviewTeam-Based Models for End-of-Life Care: An Evidence-Based Analysis.
End of life refers to the period when people are living with advanced illness that will not stabilize and from which they will not recover and will eventually die. It is not limited to the period immediately before death. Multiple services are required to support people and their families during this time period. The model of care used to deliver these services can affect the quality of the care they receive. ⋯ Moderate-quality evidence shows that a comprehensive, direct-contact, team-based model of care provides the following benefits for end-of-life patients with an estimated survival of up to 9 months: it improves caregiver satisfaction and increases the odds of dying at home while decreasing the odds of dying in a nursing home. Moderate-quality evidence also shows that improvement in patient quality of life, symptom management, and patient satisfaction occur when end-of-life care via this model is provided early (up to 24 months before death). However, using this model to deliver end-of-life care does not impact hospital admissions or hospital length of stay. Team membership includes at minimum a physician and nurse, with at least one having specialist training and/or experience in end-of-life care. Team services include symptom management, psychosocial care, development of patient care plans, end-of-life care planning, and coordination of care.
-
Ont Health Technol Assess Ser · Jan 2014
ReviewEnd-of-Life Care Interventions: An Economic Analysis.
The annual cost of providing care for patients in their last year of life is estimated to account for approximately 9% of the Ontario health care budget. Access to integrated, comprehensive support and pain/symptom management appears to be inadequate and inequitable. ⋯ In-home palliative team care was cost-effective, but firm conclusions about the cost-effectiveness of other interventions were not possible.
-
Ont Health Technol Assess Ser · Jan 2014
ReviewCardiopulmonary Resuscitation in Patients With Terminal Illness: An Evidence-Based Analysis.
Cardiopulmonary resuscitation (CPR) was first introduced in 1960 for people who unexpectedly experience sudden cardiac arrest. Over the years, it became routine practice in all institutions to perform CPR for all patients even though, for some patients with fatal conditions, application of CPR only prolongs the dying process through temporarily restoring cardiac function. ⋯ Survival after CPR depends on the severity of illness, type and number of health conditions, functional dependence, and multiple CPRs.
-
Ont Health Technol Assess Ser · Jan 2014
Review Meta AnalysisThe Determinants of Place of Death: An Evidence-Based Analysis.
According to a conceptual model described in this analysis, place of death is determined by an interplay of factors associated with the illness, the individual, and the environment. ⋯ The results obtained were consistent with previously published systematic reviews. The analysis identified several factors that are associated with place of death.
-
Ont Health Technol Assess Ser · Jan 2014
ReviewArthroscopic Debridement of the Knee: An Evidence Update.
Patients with knee pain as a result of osteoarthritis or degenerative meniscal injury may seek treatment through arthroscopic surgery. How effective arthroscopic debridement with or without meniscectomy is for relieving pain and improving patients' functional outcomes is uncertain. ⋯ The evidence does not show the superiority of arthroscopic debridement with or without meniscectomy in patients with osteoarthritis of the knee or with meniscal injury from degenerative causes.