Quality of Care Improved for Patients Nearing EOL Treated in the Home
Earlier access to palliative care may increase the likelihood that patients with hematologic malignancies nearing end-of-life (EOL) can die at home, according to research presented at the American Society of Hematology (ASH) Annual Meeting and Exposition (December 9-12, 2017; Atlanta, GA).
Current quality indicators at EOL for patients with hematologic malignancies focus on whether patients receive aggressive interventions, including chemotherapy in the last days of life. However, recent research has shown that frail patients and caregivers acknowledge that “time spent at home” represents the most important measure of EOL quality care. This patient-determined quality indicator has not been previously studied in patients with hematologic malignancies.
A group of Canadian researchers conducted a study to assess “time spent at home” as a potential patient-determined quality indicator in hematologic malignancies. Researchers used population-based health system administrative databases to identify a cohort of 6792 adult patients who died of a hematologic malignancy from 2005 to 2013. The primary outcome of the study was “days at home” in the last 6 months of life, which was defined as 180 days minus the number of days in an acute care facility, an inpatient rehabilitation facility, skilled nursing facility, or chronic care facility.
Researchers also identified patient comorbidities and system level variables—such as palliative care consultation prior to the last 6 months of life—that predicted the number of days at home and identified trends over time.
Results of the study showed that median comorbidity score was moderate-to-high and that 27% of the total patient population had received palliative care consultation prior to the last 6 months of life. Median number of days at home in the last 6 months of life was 166 days, with 81% of patients having spent more than 120 days at home over the last 6 months of life.
Additionally, researchers noted that patients who had received palliative care consultation prior to the last 6 months of life were more likely to spend time at home, compared with those who had not been received a consultation (OR, 1.34; CI, 1.20-1.49; P < .0001). In contrast, patients with more comorbidities were less likely to spend time at home within the last 6 months of life.
Researchers concluded that earlier access to palliative care may increase the likelihood that patients can die at home, which represents a “modifiable or actionable factor for physicians to consider to improve the quality of care in patients who are nearing the end of life.”—Zachary Bessette