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Research

Community-based specialist palliative care teams and health system costs at end of life: a retrospective matched cohort study

Hsien Seow, Lialoma Salam-White and Daryl Bainbridge
February 11, 2019 7 (1) E73-E80; DOI: https://doi.org/10.9778/cmajo.20180113
Hsien Seow
Department of Oncology (Seow, Bainbridge), McMaster University; Escarpment Cancer Research Institute (Seow); Juravinski Cancer Centre (Seow, Bainbridge), Hamilton, Ont.; Brant Community Healthcare System (Salam-White), Brantford, Ont.
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Lialoma Salam-White
Department of Oncology (Seow, Bainbridge), McMaster University; Escarpment Cancer Research Institute (Seow); Juravinski Cancer Centre (Seow, Bainbridge), Hamilton, Ont.; Brant Community Healthcare System (Salam-White), Brantford, Ont.
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Daryl Bainbridge
Department of Oncology (Seow, Bainbridge), McMaster University; Escarpment Cancer Research Institute (Seow); Juravinski Cancer Centre (Seow, Bainbridge), Hamilton, Ont.; Brant Community Healthcare System (Salam-White), Brantford, Ont.
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  • Figure 1:
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    Figure 1:

    Mean matched-pair differences in health care costs by team and overall, between exposed and unexposed patients in the last 30 days of life (n = 3109). Note: Error bars indicate 95% confidence intervals.

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    Figure 2:

    Mean matched-pair differences in health care sectorial costs between exposed and unexposed patients in the last 30 days of life (n = 3109). Note: Error bars indicate 95% confidence intervals.

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    Table 1:

    Team characteristics before matching

    TeamDate establishedGeographic area servedNo. decedents in FY 2009/10 and FY 2010/11Median time on service, dPalliative care physicians, no. of FTE (funding source)Nurses, no. of FTEOther team members, no. of FTE
    12009Urban830401 (FFS)82
    22009Suburban221533 (FFS)3.55
    32009Suburban144381 (FFS)10.6
    42009Suburban125401 (FFS)21
    52009Suburban105360.5 (FFS)10.2
    62009Rural90632 (APP)21.2
    71986Urban6764511.5 (APP)15.9
    82007Suburban497492 (FFS and APP)21
    91998Urban775381.3 (FFS)31.7
    102004Rural268230.6 (APP)12.5
    111979Rural181326 (FFS)24.7
    • Note: APP = alternative payment plan (i.e., physician reimbursement is a combination of FFS and salary), FFS = fee-for-service (i.e., physicians bill for each aspect of care and service they provide according to a set price mechanism), FTE = full time equivalent, FY = fiscal year.

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    Table 2:

    Comparison of patient characteristics before and after propensity score matching

    CharacteristicBefore propensity score matchingAfter propensity score matchingp value*
    UnexposedExposedUnexposedExposed
    No. of patients (pooled across the teams)41 133391231093109
    Age at death, yr, median (IQR)80 (69–87)75 (64–84)74 (63–83)75 (64–84)NS
    Cancer diagnosis, no. (%)14 443 (35.1)3073 (78.6)2481 (79.8)2469 (79.4)0.7
    Female, no. (%)20 895 (50.8)2032 (51.9)1609 (51.8)1600 (51.5)0.8
    Adjusted Clinical Group comorbidity weighting, mean ± SD5.12 ± 4.096.30 ± 4.046.21 ± 3.936.20 ± 3.98NS
    Home care service type, no. (%)
     End of life6208 (15.1)3041 (77.7)2409 (77.5)2409 (77.5)1.0
     Long-term supportive3408 (8.3)210 (5.4)145 (4.7)145 (4.7)1.0
     Maintenance7692 (18.7)328 (8.4)278 (8.9)278 (8.9)1.0
     Rehab/acute care6478 (15.7)157 (4.0)106 (3.4)106 (3.4)1.0
     None17 347 (42.2)176 (4.5)171 (5.5)171 (5.5)1.0
    Time from first receipt of most severe home care service type to death, d, mean ± SD
     End of life15.47 ± 56.4886.18 ± 107.2979.23 ± 102.0279.32 ± 102.05NS
     Long-term supportive23.92 ± 81.1731.00 ± 87.2537.96 ± 95.9227.84 ± 83.51NS
     Maintenance63.68 ± 124.8082.02 ± 131.6981.64 ± 131.0683.55 ± 132.16NS
     Rehab/acute care69.70 ± 113.2776.05 ± 113.9879.29 ± 112.6080.12 ± 114.96NS
    No. of prior emergency department visits, mean ± SD1.16 ± 2.101.43 ± 2.111.40 ± 1.951.36 ± 1.96NS
    Prior length of stay in hospital, d, mean ± SD7.18 ± 22.237.53 ± 17.096.84 ± 14.176.73 ± 14.85NS
    No. of prior hospital visits, mean ± SD0.56 ± 1.040.75 ± 1.140.76 ± 1.150.70 ± 1.07NS
    Income quintile, no. (%)
     1 (lowest)10 288 (25.0)668 (17.1)772 (24.8)536 (17.2)< 0.001
     29053 (22.0)746 (19.1)703 (22.6)605 (19.5)0.003
     37565 (18.4)720 (18.4)604 (19.4)550 (17.7)0.08
     47460 (18.1)872 (22.3)585 (18.8)675 (21.7)0.005
     5 (highest)6555 (15.9)906 (23.2)437 (14.1)743 (23.9)< 0.001
    • Note: IQR = interquartile range, NS = not significant, SD = standard deviation.

    • ↵* For characteristics reported as means and medians it was not possible to calculate actual p values at the time of publication because the individual data were no longer accessible, for privacy reasons.

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CMAJ Open: 7 (1)
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Community-based specialist palliative care teams and health system costs at end of life: a retrospective matched cohort study
Hsien Seow, Lialoma Salam-White, Daryl Bainbridge
Jan 2019, 7 (1) E73-E80; DOI: 10.9778/cmajo.20180113

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Community-based specialist palliative care teams and health system costs at end of life: a retrospective matched cohort study
Hsien Seow, Lialoma Salam-White, Daryl Bainbridge
Jan 2019, 7 (1) E73-E80; DOI: 10.9778/cmajo.20180113
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