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Sirianni G. A Public Health Approach to Palliative Care in the Canadian Context. Am J Hosp Palliat Care 2019; 37:492-496. [PMID: 31795725 DOI: 10.1177/1049909119892591] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Palliative care helps improve the quality of life of individuals facing life-limiting illness throughout the course of their disease. In Canada, delivery and access to palliative care has been fraught with challenges including differential availability of services based on geography, funding, language, and socioeconomic status. Many groups, including the World Health Organization, have advocated for a public health approach to palliative care as an antidote to fragmented service delivery. Multiple scholars, academics, and public health advocates have suggested that a public health approach to palliative care can help with issues of access, equity, and cost. Through the lens of Kingdon's Multiple Streams Framework, this commentary will explore potential reasons why a public health approach to palliative care has not been adopted in the Canadian context and why this is an opportune time to consider this policy innovation. The Compassionate Communities concept is discussed as a potential solution to a public health approach to palliative care delivery.
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Affiliation(s)
- Giovanna Sirianni
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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2
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Bremner KE, Yabroff KR, Coughlan D, Liu N, Zeruto C, Warren JL, de Oliveira C, Mariotto AB, Lam C, Barrett MJ, Chan KKW, Hoch JS, Krahn MD. Patterns of Care and Costs for Older Patients With Colorectal Cancer at the End of Life: Descriptive Study of the United States and Canada. JCO Oncol Pract 2019; 16:e1-e18. [PMID: 31647697 DOI: 10.1200/jop.19.00061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE End-of-life (EOL) cancer care is costly, with challenges regarding intensity and place of care. We described EOL care and costs for patients with colorectal cancer (CRC) in the United States and the province of Ontario, Canada, to inform better care delivery. METHODS Patients diagnosed with CRC from 2007 to 2013, who died of any cancer from 2007 to 2013 at age ≥ 66 years, were selected from the US SEER cancer registries linked to Medicare claims (n = 16,565) and the Ontario Cancer Registry linked to administrative health data (n = 6,587). We estimated total and resource-specific costs (2015 US dollars) from public payer perspectives over the last 360 days of life by 30-day periods, by stage at diagnosis (0-II, III, IV). RESULTS In all months, especially 30 days before death, higher percentages of SEER-Medicare than Ontario patients received chemotherapy (15.7% v 8.0%), and imaging tests (39.4% v 31.1%). A higher percentage of Ontario patients were hospitalized (62.5% v 51.0%), but 43.2% of hospitalized SEER-Medicare patients had intensive care unit (ICU) admissions versus 17.9% of hospitalized Ontario patients. Cost differences between cohorts were greater for patients with stage IV disease. In the last 30 days, mean total costs for patients with stage IV disease were $15,881 (SEER-Medicare) and $12,034 (Ontario) versus $19,354 and $17,312 for stage 0-II. Hospitalization costs were higher for SEER-Medicare patients ($11,180 v $9,434), with lower daily hospital costs in Ontario ($1,067 v $2,004). CONCLUSION These findings suggest opportunities for reducing chemotherapy and ICU use in the United States and hospitalizations in Ontario.
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Affiliation(s)
- Karen E Bremner
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.,Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada
| | - K Robin Yabroff
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Diarmuid Coughlan
- National Cancer Institute, Rockville, MD.,Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ning Liu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | | | | - Claire de Oliveira
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | | | - Clara Lam
- National Cancer Institute, Rockville, MD
| | | | - Kelvin K-W Chan
- University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada and Toronto, Ontario, Canada
| | - Jeffrey S Hoch
- University of Toronto, Toronto, Ontario, Canada.,University of California, Davis, Davis, CA
| | - Murray D Krahn
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.,Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
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Guérin E, Batista R, Hsu AT, Gratton V, Chalifoux M, Prud'homme D, Tanuseputro P. Does End-of-Life Care Differ for Anglophones and Francophones? A Retrospective Cohort Study of Decedents in Ontario, Canada. J Palliat Med 2019; 22:274-281. [DOI: 10.1089/jpm.2018.0233] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Eva Guérin
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
- Hôpital Montfort, Ottawa, Ontario, Canada
| | - Ricardo Batista
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
- Institute for Clinical Evaluative Sciences (ICES), Ottawa, Ontario, Canada
| | - Amy T. Hsu
- Institute for Clinical Evaluative Sciences (ICES), Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Valérie Gratton
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
- Hôpital Montfort, Ottawa, Ontario, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Mathieu Chalifoux
- Institute for Clinical Evaluative Sciences (ICES), Ottawa, Ontario, Canada
| | - Denis Prud'homme
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Institute for Clinical Evaluative Sciences (ICES), Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Li Z, Jiang S, He R, Dong Y, Pan Z, Xu C, Lu F, Zhang P, Zhang L. Trajectories of Hospitalization Cost Among Patients of End-Stage Lung Cancer: A Retrospective Study in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122877. [PMID: 30558272 PMCID: PMC6313636 DOI: 10.3390/ijerph15122877] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/24/2018] [Accepted: 12/10/2018] [Indexed: 12/24/2022]
Abstract
This study was conducted to investigate the trajectory of hospitalization costs, and to assess the determinants related to the membership of the identified trajectories, with the view of recommending future research directions. A retrospective study was performed in urban Yichang, China, where a total of 134 end-stage lung cancer patients were selected. The latent class analysis (LCA) model was used to investigate the heterogeneity in the trajectory of hospitalization cost amongst the different groups that were identified. A multi-nominal logit model was applied to explore the attributes of different classes. Three classes were defined as follows: Class 1 represented the trajectory with minimal cost, which had increased over the last two months. Classes 2 and 3 consisted of patients that incurred high costs, which had declined with the impending death of the patient. Patients in class 3 had a higher average cost than those in Class 2. The level of education, hospitalization, and place of death, were the attributes of membership to the different classes. LCA was useful in quantifying heterogeneity amongst the patients. The results showed the attributes were embedded in hospitalization cost trajectories. These findings are applicable to early identification and intervention in palliative care. Future studies should focus on the validation of the proposed model in clinical settings, as well as to identify the determinants of early discharge or aggressive care.
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Affiliation(s)
- Zhong Li
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Shan Jiang
- School of Health Policy and Management, Nanjing Medical University, Nanjing 211166, China.
| | - Ruibo He
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Yihan Dong
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Zijin Pan
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Chengzhong Xu
- Yichang Center for Disease Control and Prevention, Yichang 443000, China.
| | - Fangfang Lu
- Yichang Center for Disease Control and Prevention, Yichang 443000, China.
| | - Pei Zhang
- Yichang Center for Disease Control and Prevention, Yichang 443000, China.
| | - Liang Zhang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan 430030, China.
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Bremner KE, Krahn MD, Warren JL, Hoch JS, Barrett MJ, Liu N, Barbera L, Yabroff KR. An international comparison of costs of end-of-life care for advanced lung cancer patients using health administrative data. Palliat Med 2015; 29:918-28. [PMID: 26330452 DOI: 10.1177/0269216315596505] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patterns of end-of-life cancer care differ in Canada and the United States; yet little is known about differences in service-specific and overall costs. AIM The aim of this study was to compare end-of-life costs in Ontario, Canada, and the United States, using administrative health data. DESIGN Advanced-stage nonsmall cell lung cancer patients who died from cancer at age ⩾ 65.5 years in 2001-2005 were selected from the US Surveillance, Epidemiology, and End Results-Medicare database (N = 16,858) and the Ontario Cancer Registry (N = 8643). We estimated total and service-specific costs (2009 US dollars) in each of the last 6 months of life from the public payer perspectives for short-term and long-term survivors (lived < 180 and ⩾ 180 days post-diagnosis, respectively). Services were defined for comparisons between systems. RESULTS Mean monthly costs increased as death approached, were higher in short-term than long-term survivors, and were generally higher in the United States than in Ontario until the month before death, when they were similar (long-term survivors: US$10,464 and US$10,094 (p = 0.53), short-term survivors US$14,455 and US$12,836 (p = 0.11), in Surveillance, Epidemiology, and End Results-Medicare and Ontario, respectively). Costs for Medicare hospice and Ontario's palliative care components were similar and increased closer to death. Inpatient hospitalization was the main cost driver with similar costs in both cohorts, despite lower utilization in the United States. The compositions of many services and costs differed. CONCLUSION Costs for nonsmall cell lung cancer patients were slightly higher in the United States than Ontario until 1 month before death. Administrative data allow exploration and international comparisons of reimbursement policies, health-care delivery, and costs at the end of life.
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Affiliation(s)
- Karen E Bremner
- Toronto General Research Institute, University Health Network, Toronto, ON, Canada
| | - Murray D Krahn
- Toronto General Research Institute, University Health Network, Toronto, ON, Canada Toronto Health Economics and Technology Assessment Collaborative, Faculty of Pharmacy, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Joan L Warren
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Jeffrey S Hoch
- Toronto Health Economics and Technology Assessment Collaborative, Faculty of Pharmacy, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada Institute for Clinical Evaluative Sciences, Toronto, ON, Canada Canadian Centre for Applied Research in Cancer Control, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, ON, Canada
| | | | - Ning Liu
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Lisa Barbera
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - K Robin Yabroff
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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Hu W, Yasui Y, White J, Winget M. Aggressiveness of end-of-life care for patients with colorectal cancer in Alberta, Canada: 2006-2009. J Pain Symptom Manage 2014; 47:231-44. [PMID: 23870414 DOI: 10.1016/j.jpainsymman.2013.03.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Revised: 03/14/2013] [Accepted: 03/29/2013] [Indexed: 11/24/2022]
Abstract
CONTEXT North American studies have documented practice variations and deficiencies in end-of-life (EOL) cancer care, such as trends toward treating dying patients aggressively and disparities in access to palliative care or hospice services. OBJECTIVES To assess the frequency of aggressive health care usage at the EOL and identify factors associated with receiving aggressive care among patients who died of colorectal cancer. METHODS Data from the Alberta Cancer Registry, in/outpatient hospital records, and cancer electronic medical records were linked. Death in an acute care hospital, chemotherapy use in the last 14 days of life, more than one emergency room (ER) visit, more than one hospital admission, and any intensive care unit (ICU) admission in the last 30 days of life were used as indicators of aggressive care. Logistic regression was used to identify risk factors associated with each indicator. RESULTS A total of 2074 patients were included: 50.1% died in an acute care hospital; 3.7% received chemotherapy in the last 14 days of life; and 12.5% had multiple ER visits, 9.5% had multiple hospitalizations, and 2.2% had an ICU admission during the last 30 days of life. Age had the strongest association with chemotherapy use. Geographical region of residence had the strongest association with multiple ER visits and hospitalizations and dying in an acute care hospital. Tumor stage and duration of disease were associated with the ICU admission. CONCLUSION The percentage of patients who died in an acute care hospital is higher than the 17% U.S. benchmark. Other indicators of receiving aggressive EOL care are consistent with existing care quality benchmarks. The considerable regional variation, however, indicates potential for system improvements.
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Affiliation(s)
- Weihong Hu
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Yutaka Yasui
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jonathan White
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Marcy Winget
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Cancer Care, Alberta Health Services, Edmonton, Alberta, Canada.
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Lauck S, Garland E, Achtem L, Forman J, Baumbusch J, Boone R, Cheung A, Ye J, Wood DA, Webb JG. Integrating a palliative approach in a transcatheter heart valve program: bridging innovations in the management of severe aortic stenosis and best end-of-life practice. Eur J Cardiovasc Nurs 2014; 13:177-84. [PMID: 24477655 DOI: 10.1177/1474515114520770] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Severe aortic stenosis (AS) is the most prevalent structural heart disease and affects primarily older adults in their last decade of life. If the risk for surgery is high, transcatheter aortic valve implantation (TAVI) is the treatment of choice for many patients with suitable anatomy who are likely to derive significant benefit from this innovative and minimally invasive approach. In a large transcatheter heart valve (THV) centre that offers TAVI as one of the treatment options, of 565 consecutive referrals for the assessment of eligibility for TAVI over 18 months, 78 (14%) were deemed unsuitable candidates for TAVI or higher risk surgery by the interdisciplinary Heart Team because of their advanced disease, excessive frailty or comorbid burden. Concerns were raised for patients for whom TAVI is not an option. The integration of a palliative approach in a THV program offers opportunities to adopt best end-of-life practices while promoting innovative approaches for treatment. An integrated palliative approach to care focuses on meeting a patient's full range of physical, psychosocial and spiritual needs at all stages of a life-limiting illness, and is well suited for the severe AS and TAVI population. A series of interventions that reflect best practices and current evidence were adopted in collaboration with the Palliative Care Team and are currently under evaluation in a large TAVI centre. Changes include the introduction of a palliative approach in patient assessment and education, the measurement of symptoms, improved clarity about responsibility for communication and follow-up, and triggering referrals to palliative care services.
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Pesut B, Hooper B, Sawatzky R, Robinson CA, Bottorff JL, Dalhuisen M. Program assessment framework for a rural palliative supportive service. Palliat Care 2013; 7:7-17. [PMID: 25278757 PMCID: PMC4147755 DOI: 10.4137/pcrt.s11908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Although there are a number of quality frameworks available for evaluating palliative services, it is necessary to adapt these frameworks to models of care designed for the rural context. The purpose of this paper was to describe the development of a program assessment framework for evaluating a rural palliative supportive service as part of a community-based research project designed to enhance the quality of care for patients and families living with life-limiting chronic illness. A review of key documents from electronic databases and grey literature resulted in the identification of general principles for high-quality palliative care in rural contexts. These principles were then adapted to provide an assessment framework for the evaluation of the rural palliative supportive service. This framework was evaluated and refined using a community-based advisory committee guiding the development of the service. The resulting program assessment framework includes 48 criteria organized under seven themes: embedded within community; palliative care is timely, comprehensive, and continuous; access to palliative care education and experts; effective teamwork and communication; family partnerships; policies and services that support rural capacity and values; and systematic approach for measuring and improving outcomes of care. It is important to identify essential elements for assessing the quality of services designed to improve rural palliative care, taking into account the strengths of rural communities and addressing common challenges. The program assessment framework has potential to increase the likelihood of desired outcomes in palliative care provisions in rural settings and requires further validation.
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Affiliation(s)
- Barbara Pesut
- School of Nursing, University of British Columbia, Kelowna, British Columbia, Canada
| | - Brenda Hooper
- School of Nursing, University of British Columbia, Kelowna, British Columbia, Canada
- Coordinator, Rural Palliative Supportive Service, British Columbia, Canada
| | - Richard Sawatzky
- School of Nursing, Trinity Western University, Langley, British Columbia, Canada
- Centre for Health Outcomes and Evaluation Sciences, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Carole A Robinson
- School of Nursing, University of British Columbia, Kelowna, British Columbia, Canada
| | - Joan L Bottorff
- School of Nursing, University of British Columbia, Kelowna, British Columbia, Canada
| | - Miranda Dalhuisen
- School of Nursing, University of British Columbia, Kelowna, British Columbia, Canada
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Palliative care case management in primary care settings: a nationwide survey. Int J Nurs Stud 2013; 50:1504-12. [PMID: 23545141 DOI: 10.1016/j.ijnurstu.2013.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 02/26/2013] [Accepted: 03/02/2013] [Indexed: 01/20/2023]
Abstract
BACKGROUND In case management an individual or small team is responsible for navigating the patient through complex care. Characteristics of case management within and throughout different target groups and settings vary widely. Case management is relatively new in palliative care. Insight into the content of care and organisational characteristics of case management in palliative care is needed. OBJECTIVES To investigate how many case management initiatives for palliative care there are in the Netherlands for patients living at home; to describe the characteristics of these initiatives with regard to content and organisation of care. SETTING Primary care. DESIGN AND PARTICIPANTS A nationwide survey of all 50 coordinators of networks in palliative care in the Netherlands was conducted. Additional respondents were found through snowball sampling. We looked at 33 possible initiatives using interviews (n=33) and questionnaires (n=30). RESULTS We identified 20 initiatives for case management. All stated that case management is supplemental to other care. In all initiatives the case managers are registered nurses and most possess higher vocational education and/or further training. All initiatives seek to identify the multidimensional care needs of the patients and the relatives and friends who care for them. Almost all provide information and support and refer patients who need care. Differences are found between the organisations offering the case management, their target groups, the names of the initiatives and whether direct patient care is provided by the case manager. CONCLUSIONS In the Netherlands, case management in palliative care is new. Several models of delivery were identified. Research is needed to gain insight into the best way to deliver case management. By describing characteristics of case management in palliative care, an important first step is made in identifying effective elements of case management.
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Klinger CA, Howell D, Marshall D, Zakus D, Brazil K, Deber RB. Resource utilization and cost analyses of home-based palliative care service provision: the Niagara West End-of-Life Shared-Care Project. Palliat Med 2013; 27:115-22. [PMID: 22249926 DOI: 10.1177/0269216311433475] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Increasing emphasis is being placed on the economics of health care service delivery - including home-based palliative care. AIM This paper analyzes resource utilization and costs of a shared-care demonstration project in rural Ontario (Canada) from the public health care system's perspective. DESIGN To provide enhanced end-of-life care, the shared-care approach ensured exchange of expertise and knowledge and coordination of services in line with the understood goals of care. Resource utilization and costs were tracked over the 15 month study period from January 2005 to March 2006. RESULTS Of the 95 study participants (average age 71 years), 83 had a cancer diagnosis (87%); the non-cancer diagnoses (12 patients, 13%) included mainly advanced heart diseases and COPD. Community Care Access Centre and Enhanced Palliative Care Team-based homemaking and specialized nursing services were the most frequented offerings, followed by equipment/transportation services and palliative care consults for pain and symptom management. Total costs for all patient-related services (in 2007 $CAN) were $1,625,658.07 - or $17,112.19 per patient/$117.95 per patient day. CONCLUSION While higher than expenditures previously reported for a cancer-only population in an urban Ontario setting, the costs were still within the parameters of the US Medicare Hospice Benefits, on a par with the per diem funding assigned for long-term care homes and lower than both average alternate level of care and hospital costs within the Province of Ontario. The study results may assist service planners in the appropriate allocation of resources and service packaging to meet the complex needs of palliative care populations.
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Affiliation(s)
- Christopher A Klinger
- University of Toronto, Institute of Health Policy, Management and Evaluation, Canada
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Wilson DM, Thomas R, Kovacs Burns KK, Hewitt JA, Osei-Waree J, Robertson S. Canadian rural-urban differences in end-of-life care setting transitions. Glob J Health Sci 2012; 4:1-13. [PMID: 22980372 PMCID: PMC4776943 DOI: 10.5539/gjhs.v4n5p1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Accepted: 06/12/2012] [Indexed: 12/04/2022] Open
Abstract
Few studies have focused on the care setting transitions that occur in the last year of life. A three part mixed-methods study was conducted to gain an understanding of the number and implications or impact of care setting transitions in the last year of life for rural Canadians. Provincial health services utilization data, national online survey data, and local qualitative interview data were analyzed to gain general and specific information for consideration. Rural Albertans had significantly more healthcare setting transitions than urbanites in the last year of life (M=4.2 vs 3.3). Online family respondents reported 8 moves on average occurred for family members in the last year of life. These moves were most often identified (65%) on a likert-type scale as “very difficult,” with the free text information revealing these trips were often emotionally painful for themselves and physically painful for their ill family member. Eleven informants were then interviewed until data saturation, with constant-comparative data analysis conducted for a more in-depth understanding of rural transitions. Moving from place to place for needed care in the last year of life was identified as common and concerning for rural people and their families, with three data themes developing: (a) needed care in the last year of life is scattered across many places, (b) travelling is very difficult for terminally-ill persons and their caregivers, and (c) local rural services are minimal. These findings indicate planning is needed to avoid unnecessary end-of-life care setting transitions and to make needed moves for essential services in the last year of life less costly, stressful, and socially disruptive for rural people and their families.
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Affiliation(s)
- Donna M Wilson
- Faculty of Nursing, University of Alberta, Edmonton, Canada.
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Williams AM, Eby JA, Crooks VA, Stajduhar K, Giesbrecht M, Vuksan M, Cohen SR, Brazil K, Allan D. Canada's Compassionate Care Benefit: is it an adequate public health response to addressing the issue of caregiver burden in end-of-life care? BMC Public Health 2011; 11:335. [PMID: 21592383 PMCID: PMC3123207 DOI: 10.1186/1471-2458-11-335] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Accepted: 05/18/2011] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND An increasingly significant public health issue in Canada, and elsewhere throughout the developed world, pertains to the provision of adequate palliative/end-of-life (P/EOL) care. Informal caregivers who take on the responsibility of providing P/EOL care often experience negative physical, mental, emotional, social and economic consequences. In this article, we specifically examine how Canada's Compassionate Care Benefit (CCB)--a contributory benefits social program aimed at informal P/EOL caregivers--operates as a public health response in sustaining informal caregivers providing P/EOL care, and whether or not it adequately addresses known aspects of caregiver burden that are addressed within the population health promotion (PHP) model. METHODS As part of a national evaluation of Canada's Compassionate Care Benefit, 57 telephone interviews were conducted with Canadian informal P/EOL caregivers in 5 different provinces, pertaining to the strengths and weaknesses of the CCB and the general caregiving experience. Interview data was coded with Nvivo software and emerging themes were identified by the research team, with such findings published elsewhere. The purpose of the present analysis was identified after comparing the findings to the literature specific to caregiver burden and public health, after which data was analyzed using the PHP model as a guiding framework. RESULTS Informal caregivers spoke to several of the determinants of health outlined in the PHP model that are implicated in their burden experience: gender, income and social status, working conditions, health and social services, social support network, and personal health practises and coping strategies. They recognized the need for improving the CCB to better address these determinants. CONCLUSIONS This study, from the perspective of family caregivers, demonstrates that the CCB is not living up to its full potential in sustaining informal P/EOL caregivers. Effort is required to transform the CCB so that it may fulfill the potential it holds for serving as one public health response to caregiver burden that forms part of a healthy public policy that addresses the determinants of this burden.
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Affiliation(s)
- Allison M Williams
- Department of Geography and Earth Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jeanette A Eby
- Department of Geography and Earth Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Valorie A Crooks
- Department of Geography, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Kelli Stajduhar
- School of Nursing and Centre On Aging, University of Victoria, Victoria, British Columbia, Canada
| | - Melissa Giesbrecht
- Department of Geography, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Mirjana Vuksan
- Department of Geography and Earth Sciences, McMaster University, Hamilton, Ontario, Canada
| | - S Robin Cohen
- Department of Oncology, McGill University, Montreal, Québec, Canada
| | - Kevin Brazil
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Diane Allan
- Centre On Aging, University of Victoria, Victoria, British Columbia, Canada
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