Home palliative care reduces emergency room visits and deaths in health centers at a lower cost

Ovares, José Ernesto Picado

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Revista Brasileira de Geriatria e Gerontologia

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Original Articles • Rev. bras. geriatr. gerontol. 24 (5) • 2021 • https://doi.org/10.1590/1981-22562021024.210112 copy

Home palliative care reduces emergency room visits and deaths in health centers at a lower cost

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives

To compare the types of geriatric and palliative home care to determine which has better outcomes in patients with advanced dementia.

Methods

This is a retrospective cohort study. Patients with advanced dementia admitted to the Geriatric Community Care program of a public geriatric hospital in Costa Rica in the period between January 2018 and June 2019 were included. They were divided into two groups depending on the specialized team that performed the home care, and their sociodemographic and clinical characteristics were analyzed. Subsequently, data generated from medical records on emergency consultations, hospitalization, place of death and cost of the visit generated by each patient between June 2018 and December 2019 were analyzed. A comparison was made between 192 patients with advanced Global Dementia Scale 7 dementia visited by the specialized geriatric home care team and 19 patients visited by the specialized palliative home care team of the National Geriatric Hospital.

Results

We analyzed 226 data generated (192 by the geriatric program and 34 by the palliative program). Those receiving home care by a palliative team were less likely to go to the emergency room and die in a health center compared to those receiving home care by a geriatric team, at a lower cost.

Conclusions

The specialized palliative home care program reduces emergency room visits, death at home, and costs of care in patients with advanced dementia compared with the geriatric program.

Keywords
Palliative Care; Geriatrics; Dementia; Home Care Services; Terminal Care; Cost-Benefit Analysis; Health Services

Modality of care	Patients visited	Description of program and services offered
Specialized geriatric home care	Non-oncologic terminal illness	Visits by a multidisciplinary team a that includes ^a geriatric specialist ^b Visits every 2 to 3 months. Teleconsultation available during office hours. Caregiver training group. Bereavement group.
Specialized palliative home care	Terminal oncologic and non-oncologic illness	Visits by a multidisciplinary team including a specialist in geriatrics and palliative care. Visits every month or as needed. Teleconsultation available 24/7. Caregiver training group. Bereavement group.

Variable	Geriatric Program n=192 (100%)	CI	Palliative program n=34 (100%)	CI
Average length of stay (days)	407.4	377.5; 436.5	426.1	286.9; 565.1
Average age	85.2 (SD=7,9)	84.1; 86.3	86.9 (SD=7,8)	82.7; 91.2
Marital status
Widowed	93 (48.2%)	41.1; 55.3	16 (47.4%)	24.9; 64.8
Married	60 (30.9%)	24.3; 37.4	14 (42.1%)	19.9; 64.3
Single	26 (13.6%)	8.7; 18.5	2 (5.3%)	0.0; 15.3
Other	14 (7.3%)	3.6; 11.0	2 (5.3%)	0.0; 15.3
Gender
Female	141 (73.4%)	67.2; 79.7	25 (73.7%)	53.9; 93.5
Male	51 (26.6%)	20.3; 32.8	9 (26.3%)	6.5; 46.1
Primary Caregiver
Family	154 (80.2%)	74.5; 85.9	28 (83.3%)	66.1; 100.0
Hired personnel	38 (19.8%)	14.1; 25.5	6 (16.7%)	0.0; 33.9
Pressure ulcers grade 3 or 4
Yes	27 (14.2%)	9.2; 19.2	2 (5.3%)	0.0; 15.3
Nasogastric tube or PEG^a
Yes	42 (22.1%)	16.2; 28.0	14 (42.1%)	19.9; 64.3
Bladder catheter
Yes	11 (5.8%)	2.5; 9.1	5 (15.8%)	0.0; 32.2

Variable	Palliative program
Variable	OR^1/	CI
Consultations to the emergency service
Yes	0,18	0,09; 0,35 *.
Hospitalization
Yes	0,46	0,07; 1,56
Place of death
Health center	0,16	0,01; 0,93 *

Variables	Program
Variables	Geriatric	Palliative
General variables
Total patients at the beginning of the study	192	19
Total patients at the end of the study	192	34
Data evaluated	419	46
Cost of home care per patient	$ 368,4^a	$ 680
Variables of emergency department visits
Patients who visited the emergency department	106	4
Total number of emergency department visits	295	14
Time (in hours) of emergency department visits	1630	153,4
Total cost of care in the emergency department	$ 76858,4	$ 5607,7
Cost of emergency care per patient	$ 400	$ 165
Hospitalization variables
Hospitalized patients	32	2
Total hospitalizations	38	2
Total days of hospitalization	574	26
Cost of one day of hospitalization (average)^a	$ 802	$ 802
Cost per hospitalized patient	$ 1759	$ 485
Other variables
Cost of 24/7 teleconsultation	n/a^b	$ 51,13
Total cost per patient ^c	$ 2527,4	$ 1381,1

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[1] Correspondence José Ernesto Picado Ovares jepicado@ccss.sa.cr