Association of primary and community care services with emergency visits and hospital admissions at the end of life in people with cancer: a retrospective cohort study

TY - JOUR

T1 - Association of primary and community care services with emergency visits and hospital admissions at the end of life in people with cancer

T2 - a retrospective cohort study

AU - Leniz, Javiera

AU - Henson, Lesley A.

AU - Potter, Jean

AU - Gao, Wei

AU - Newsom-Davis, Tom

AU - Ul-Haq, Zia

AU - Lucas, Amanda

AU - Higginson, Irene J.

AU - Sleeman, Katherine E.

N1 - Funding Information: JL wrote the first draft of the paper. All authors contributed to subsequent drafts and approved the final paper. JL act as the guarantor accepting full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish. Funding JL is funded by a Royal Marsden Partners Pan London Research Fellowship Award and the Programa Formacion de Capital Humano Avanzado, Doctorado Becas Chile, 2018 (folio 72190265). KES is funded by a National Institute of Health Research (NIHR) Clinician Scientist Fellowship (CS-2015-15-005) and is the Laing Galazka Chair in Palliative Care at King’s College London, funded by an endowment from Cicely Saunders International and the Kirby Laing Foundation. IJH is an NIHR Senior Investigator Emeritus. IJH is supported by the NIHR Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust. IJH leads the Palliative and End of Life Care theme of the NIHR ARC South London, and coleads the national theme in this. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care or the funding charities. Competing interests None declared. Patient consent for publication Not required. Publisher Copyright: © 2022 BMJ Publishing Group. All rights reserved.

PY - 2022/2/23

Y1 - 2022/2/23

N2 - OBJECTIVE: To examine the association between primary and community care use and measures of acute hospital use in people with cancer at the end of life. DESIGN: Retrospective cohort study. SETTING: We used Discover, a linked administrative and clinical data set from general practices, community and hospital records in North West London (UK). PARTICIPANTS: People registered in general practices, with a diagnosis of cancer who died between 2016 and 2019. PRIMARY AND SECONDARY OUTCOME MEASURES: ≥3 hospital admissions during the last 90 days, ≥1 admissions in the last 30 days and ≥1 emergency department (ED) visit in the last 2 weeks of life. RESULTS: Of 3581 people, 490 (13.7%) had ≥3 admissions in last 90 days, 1640 (45.8%) had ≥1 admission in the last 30 days, 1042 (28.6%) had ≥1 ED visits in the last 2 weeks; 1069 (29.9%) had more than one of these indicators. Contacts with community nurses in the last 3 months (≥13 vs <4) were associated with fewer admissions in the last 30 days (risk ratio (RR) 0.88, 95% CI 0.90 to 0.98) and ED visits in the last 2 weeks of life (RR 0.79, 95% CI 0.68 to 0.92). Contacts with general practitioners in the last 3 months (≥11 vs <4) was associated with higher risk of ≥3 admissions in the last 90 days (RR 1.63, 95% CI 1.33 to 1.99) and ED visits in the last 2 weeks of life (RR 1.27, 95% CI 1.10 to 1.47). CONCLUSIONS: Expanding community nursing could reduce acute hospital use at the end of life and improve quality of care.

AB - OBJECTIVE: To examine the association between primary and community care use and measures of acute hospital use in people with cancer at the end of life. DESIGN: Retrospective cohort study. SETTING: We used Discover, a linked administrative and clinical data set from general practices, community and hospital records in North West London (UK). PARTICIPANTS: People registered in general practices, with a diagnosis of cancer who died between 2016 and 2019. PRIMARY AND SECONDARY OUTCOME MEASURES: ≥3 hospital admissions during the last 90 days, ≥1 admissions in the last 30 days and ≥1 emergency department (ED) visit in the last 2 weeks of life. RESULTS: Of 3581 people, 490 (13.7%) had ≥3 admissions in last 90 days, 1640 (45.8%) had ≥1 admission in the last 30 days, 1042 (28.6%) had ≥1 ED visits in the last 2 weeks; 1069 (29.9%) had more than one of these indicators. Contacts with community nurses in the last 3 months (≥13 vs <4) were associated with fewer admissions in the last 30 days (risk ratio (RR) 0.88, 95% CI 0.90 to 0.98) and ED visits in the last 2 weeks of life (RR 0.79, 95% CI 0.68 to 0.92). Contacts with general practitioners in the last 3 months (≥11 vs <4) was associated with higher risk of ≥3 admissions in the last 90 days (RR 1.63, 95% CI 1.33 to 1.99) and ED visits in the last 2 weeks of life (RR 1.27, 95% CI 1.10 to 1.47). CONCLUSIONS: Expanding community nursing could reduce acute hospital use at the end of life and improve quality of care.

KW - epidemiology

KW - palliative care

KW - primary care

KW - quality in health care

UR - http://www.scopus.com/inward/record.url?scp=85125154882&partnerID=8YFLogxK

U2 - 10.1136/bmjopen-2021-054281

DO - 10.1136/bmjopen-2021-054281

M3 - Article

C2 - 35197345

AN - SCOPUS:85125154882

SN - 2044-6055

VL - 12

SP - e054281

JO - BMJ Open

JF - BMJ Open

IS - 2

M1 - e054281

ER -