RT Journal Article
SR Electronic
T1 Utilization and costs of home care for patients with colorectal cancer: a population-based study
JF CMAJ Open
FD Canadian Medical Association
SP E11
OP E17
DO 10.9778/cmajo.20130026
VO 2
IS 1
A1 Nicole Mittmann
A1 Ning Liu
A1 Joan Porter
A1 Soo Jin Seung
A1 Hon
A1 Pierre K. Isogai
A1 Refik Saskin
A1 Matthew C. Cheung
A1 Natasha B. Leighl
A1 Jeffrey S. Hoch
A1 Maureen Trudeau
A1 William K. Evans
A1 Katie N. Dainty
A1 Craig C. Earle
YR 2014
UL http://www.cmajopen.ca/content/2/1/E11.abstract
AB Background The utilization and costs of home care services provided for people with colorectal cancer is not well-known. We conducted an analysis to determine the utilization and costs of such services associated with each stage of colorectal cancer among patients in the province of Ontario. Methods We included cases of colorectal cancer diagnosed in Ontario between Jan. 1, 2005, and Dec. 31, 2009. Data were extracted from the Ontario Cancer Registry and linked to data from a home care administrative database. The types of services used were stratified by stage of disease and by phase of care (initial phase = 180 d after diagnosis, terminal phase = 180 d before death, continuing phase = interval between initial and terminal phases). Overall utilization rates and costs were determined, and regression analysis was used to examine associated factors. Results A total of 36 195 patients had colorectal cancer diagnosed during the study period; the median age was 71 (interquartile range 61–79) years. Home care services were provided to 24 641 patients (68.1%). The number of services per patient-year was 27.5, at a cost of $2180 per patient-year. The number of services provided per patient-year increased with increasing disease severity at diagnosis (15.5 at stage I, 25.5 at stage II, 32.5 at stage III and 62.5 at stage IV; 22.6 for unstaged disease). The cost of services per patient-year also increased with disease severity at diagnosis ($1170 at stage I, $1995 at stage II, $2727 at stage III and $5541 at stage IV). Publicly funded home care services and associated costs decreased with increasing income group, but they increased among patients who had a history of high health resource utilization. The mean 30-day cost of home care services decreased from the initial phase of care ($323) to the continuing phase ($160) but increased during the terminal phase ($616). Interpretation More than two-thirds of the patients with colorectal cancer in this study used home care services. Those who received home care services used about 2 services per month in a one-year period, at a cost of about $2000 per year. This information can aid policy-makers in future decisions regarding resource allocations.