%0 Journal Article
%T Early initiation of palliative care is associated with reduced late
%A Danial Qureshi
%A Greg R Pond
%A Hsien-Yeang Seow
%A Peter Tanuseputro
%A Richard Perez
%J Palliative Medicine
%@ 1477-030X
%D 2019
%R 10.1177/0269216318815794
%X Early palliative care can reduce end-of-life acute-care use, but findings are mainly limited to cancer populations receiving hospital interventions. Few studies describe how early versus late palliative care affects end-of-life service utilization. To investigate the association between early versus late palliative care (hospital/community-based) and acute-care use and other publicly funded services in the 2£¿weeks before death. Retrospective population-based cohort study using linked administrative healthcare data. Decedents (cancer, frailty, and organ failure) between 1 April 2010 and 31 December 2012 in Ontario, Canada. Initiation time before death (days): early (£¿60) and late (£¿15 and <60). ¡®Acute-care settings¡¯ included acute-hospital admissions with (¡®palliative-acute-care¡¯) and without palliative involvement (¡®non-palliative-acute-care¡¯). We identified 230,921 decedents. Of them, 27% were early palliative care recipients and 13% were late; 45% of early recipients had a community-based initiation and 74% of late recipients had a hospital-based initiation. Compared to late recipients, fewer early recipients used palliative-acute care (42% vs 65%) with less days (mean days: 9.6 vs 12.0). Late recipients were more likely to use acute-care settings; this was further modified by disease: comparing late to early recipients, cancer decedents were nearly two times more likely to spend >1£¿week in acute-care settings (odds ratio£¿=£¿1.84, 95% confidence interval: 1.83¨C1.85), frailty decedents were three times more likely (odds ratio£¿=£¿3.04, 95% confidence interval: 3.01¨C3.07), and organ failure decedents were four times more likely (odds ratio£¿=£¿4.04, 95% confidence interval: 4.02¨C4.06). Early palliative care was associated with improved end-of-life outcomes. Late initiations were associated with greater acute-care use, with the largest influence on organ failure and frailty decedents, suggesting potential opportunities for improvement
%K Palliative care
%K hospitalization
%K health services
%K end-of-life care
%K cohort studies
%K administrative claims
%K healthcare
%K Canada
%U https://journals.sagepub.com/doi/full/10.1177/0269216318815794