Effects of 24/7 palliative care consultation availability on the use of emergency department and emergency medical services resources from non-oncological patients: a before-and-after observational cohort study.

Autor:	Valenti D; Palliative Care Network, AUSL di Bologna, Bologna, Italy., Gamberini L; Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy lorenzo.gamberini86@gmail.com., Allegri D; Department of Clinical Governance and Quality, AUSL di Bologna, Bologna, Italy., Tartaglione M; Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy., Moggia F; Palliative Care Network, AUSL di Bologna, Bologna, Italy., Del Giudice D; EMS 118 Regional Programme, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy., Baroni R; Management Staff - Business Information Systems, AUSL di Bologna, Bologna, Italy., Di Mirto CVF; Palliative Care Network, AUSL di Bologna, Bologna, Italy., Tamanti J; Palliative Care Network, AUSL di Bologna, Bologna, Italy., Rosa S; Palliative Care Network, AUSL di Bologna, Bologna, Italy., Paoletti S; Palliative Care Network, AUSL di Bologna, Bologna, Italy., Bruno L; Palliative Care Network, AUSL di Bologna, Bologna, Italy., Peterle C; Palliative Care Network, AUSL di Bologna, Bologna, Italy., Cuomo AMR; Palliative Care Network, AUSL di Bologna, Bologna, Italy., Bertini A; Emergency Medicine, Emergency Department, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy., Giostra F; Emergency Medicine, Emergency Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy., Mengoli F; Palliative Care Network, AUSL di Bologna, Bologna, Italy.
Jazyk:	angličtina
Zdroj:	BMJ supportive & palliative care [BMJ Support Palliat Care] 2023 Nov 16. Date of Electronic Publication: 2023 Nov 16.
DOI:	10.1136/spcare-2023-004412
Abstrakt:	Objectives: The non-oncological population is relatively under-represented among end-of-life (EOL) patients managed by palliative care (PC) services, and the effects of different PC delivery models are understudied in this population.This retrospective observational study on routinely collected data aimed at evaluating the effects of the extension from workday-only to 24/7 mixed hands-on and advisory home PC service on emergency department (ED) access and emergency medical services (EMS) interventions needed by non-oncological patients during their last 90 days of life, and their probability to die in hospital. Methods: A before-and-after design was adopted comparing preimplementation and postimplementation periods (2018-2019 and 2021-22).We used a difference-in-differences approach to estimate changes in ED access and EMS intervention rates in the postintervention period through binomial negative regression. The oncological population, always exposed to 24/7 PC, was used as a control. A robust Poisson regression model was adopted to investigate the differences regarding hospital mortality. The analyses were adjusted for age, sex and disease grouping by the system involved. Results were reported as incidence rate ratios (IRRs) and ORs. Results: A total of 2831 patients were enrolled in the final analysis.After the implementation of 24/7 home PC, both ED admissions (IRR=0.390, p<0.001) and EMS interventions (IRR=0.413, p<0.001) dropped, as well as the probability to die in hospital (OR=0.321, p<0.001). Conclusions: The adoption of a 24/7 mixed hands-on and advisory model of home PC could have relevant effects in terms of ED access and EMS use by non-oncological EOL patients under PC. Trial Regisration Number: NCT05640076. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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