Open AccessAssociations between physician home visits for the dying and place of death: A population-based retrospective cohort study
Author(s) -
Peter Tanuseputro,
Sarah Beach,
Mathieu Chalifoux,
Walter P. Wodchis,
Amy T Hsu,
Hsien Seow,
Manuel Dujovny
Publication year - 2018
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0191322
Subject(s) - medicine , odds ratio , palliative care , place of death , end of life care , retrospective cohort study , odds , population , cohort study , cohort , acute care , health care , family medicine , emergency medicine , logistic regression , nursing , environmental health , economics , economic growth
Background While most individuals wish to die at home, the reality is that most will die in hospital. Aim To determine whether receiving a physician home visit near the end-of-life is associated with lower odds of death in a hospital. Design Observational retrospective cohort study, examining location of death and health care in the last year of life. Setting/Participants Population-level study of Ontarians, a Canadian province with over 13 million residents. All decedents from April 1, 2010 to March 31, 2013 (n = 264,754) Results More than half of 264,754 decedents died in hospital: 45.7% died in an acute care hospital and 7.7% in complex continuing care. After adjustment for multiple factors–including patient illness, home care services, and days of being at home–receiving at least one physician home visit from a non-palliative care physician was associated with a 47% decreased odds (odds-ratio, 0.53; 95%CI: 0.51–0.55) of dying in a hospital. When a palliative care physician specialist was involved, the overall odds declined by 59% (odds ratio, 0.41; 95%CI: 0.39–0.43). The same model, adjusting for physician home visits, showed that receiving palliative home care was associated with a similar reduction (odds ratio, 0.49; 95%CI: 0.47–0.51). Conclusion Location of death is strongly associated with end-of-life health care in the home. Less than one-third of the population, however, received end-of-life home care or a physician visit in their last year of life, revealing large room for improvement.