30 Oct End of Life Home Care Nursing Reduces Emergency Department Visits
MedicalResearch.com Interview with:
Dr. Hsien Seow, PhD
Associate Professor Department of Oncology
Cancer Care Ontario Research Chair in Health Services Research
Associate Member, Department of Clinical Epidemiology & Biostatistics
Canadian Institutes of Health Research Young Investigator
Medical Research: What is the background for this study? What are the main findings?
Dr. Seow: Despite being commonplace in healthcare systems, little research has described the effectiveness of publicly-provided generalist homecare nursing to reduce unnecessary acute care use at end-of-life, such as emergency department (ED) visits. It is also unclear how homecare nursing intent, which varies by standard care or end-of-life, affects this relationship. Our study examined a population-based cohort of cancer decedents in Ontario, Canada who used homecare nursing in their last six months of life. Specifically, we examined the relationship between homecare nursing rate in a given week on the ED visit rate in the subsequent week. In our cohort of 54,576 decedents, there was a temporal association between receiving end-of-life nursing in a given week during the last six months of life, and of more standard nursing in the last month of life, with a reduced ED rate in the subsequent week. Homecare nursing for those who are receving end of life care will find that it can provide immediate assistance when needed.
Medical Research: What should clinicians and patients take away from your report?
Dr. Seow: In our study, which represents the largest cohort to examine the effect of homecare nursing on ED visits in a general end-of-life cancer population to our knowledge, we found that having end-of-life nursing compared to standard nursing was associated with a reduced ED visit rate in the subsequent week by 31% across the last 26 weeks of life, and by 41% in the last month of life. Thus, homecare nursing with an end-of-life intent helps to avoid unnecessary ED visits, even more than standard nursing. The results of our study imply that once it is clear that the goals of care have an end-of-life care intent, generalist nurses, not only specialists, can provide components of palliation, such as keeping patients comfortable and pain-free, which helps to avoid unnecessary ED visits. Overall, this evidence should support health care policies that enhance the provision of homecare nursing, especially end-of-life nursing, to patients in the final weeks of life to reduce avoidable ED visits.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Seow: Future research should focus on measuring the quality of the homecare provided, identifying the nursing services provided that are most valuable to patients and families, quantifying the cost-saving potential of increasing population-level end-of-life homecare nursing and reducing acute care use, and determining whether the reasons for going to the ED were appropriate or preventable.
Does Increasing Homecare Nursing Reduce Emergency Department Visits at the End of Life? A Population-Based Cohort Study of Cancer Decedents
Dr. Hsien Seow, PhD (2015). End of Life Home Care Nursing Reduces Emergency Department Visits